儿童非生理复杂手术的发生率：基于安大略省健康管理数据的一项研究。

Incidence of non-physiologically complex surgical procedures performed in children: an Ontario population-based study of health administrative data.

机构信息

Department of Anesthesia, University of Toronto, Toronto, ON, Canada.

Department of Anesthesia and Pain Medicine, The Hospital for Sick Children, Toronto, ON, Canada.

出版信息

Can J Anaesth. 2018 Jan;65(1):23-33. doi: 10.1007/s12630-017-0993-y. Epub 2017 Nov 17.

DOI:10.1007/s12630-017-0993-y

PMID:29150783

Abstract

PURPOSE

Quantification of surgical procedures undertaken by hospitals is necessary for informing resource allocation and modelling healthcare services. Our objective was to quantify the incidence, similarity, and diversity of non-physiologically complex surgical procedures performed at pediatric specialist hospitals and other hospitals performing pediatric surgery.

METHODS

We conducted a population-based cohort study of children aged 28 days to 18 yr who underwent surgery in the province of Ontario from 2007 to 2015 using healthcare administrative databases. We estimated the incidence of non-physiologically complex procedures (i.e., ≤ 7 basic units in the 2015 Ontario Health Insurance Plan Schedule of Benefits) performed in pediatric specialist hospitals and other hospitals performing pediatric surgery. We used Yue and Clayton's index and the effective number of common procedures (1/Herfindahl index) to quantify the similarity and diversity of pediatric surgical procedures performed in these hospital types.

RESULTS

Overall, 830,830 pediatric surgical procedures were performed in 158 Ontario hospitals during the eight-year study period. Most surgical procedures performed at hospitals performing pediatric surgery were non-physiologically complex (vs 50%, P < 0.001). The incidence of non-physiologically complex procedures increased progressively each year at pediatric specialist hospitals and was associated with a reciprocal decline among the other hospitals. Comparing pediatric specialist hospitals with the other hospitals, the mean similarity index for non-physiologically complex procedures was less than moderate (0.52; 95% confidence interval [CI], 0.51 to 0.54). The mean effective number of common non-physiologically complex procedures (i.e., the diversity) among the pediatric specialist hospitals was greater than at the other 154 hospitals performing pediatric surgery (65.3 vs 21.8 procedures, respectively; mean difference, 43.5; 95% CI, 42.2 to 44.8; P < 0.001).

CONCLUSIONS

Non-physiologically complex procedures have progressively migrated to pediatric specialist hospitals from other hospitals in Ontario. Specialty pediatric hospitals are principally dissimilar from other hospitals performing pediatric surgery based not on physiological complexity, but on their diversity. These findings suggest that some types of surgical procedures may be redistributed from specialist pediatric hospitals to other hospitals performing pediatric surgery.

TRIAL REGISTRATION

www.clinicaltrials.gov , number NCT03144544. Registered 2 May 2016.

摘要

目的

量化医院开展的手术操作对于资源配置和医疗服务建模非常必要。本研究旨在量化小儿专科医院和开展小儿外科手术的其他医院实施的非生理性复杂手术的发生率、相似性和多样性。

方法

我们利用医疗保健管理数据库，对 2007 年至 2015 年期间安大略省 28 天至 18 岁行手术治疗的儿童进行了基于人群的队列研究。我们估计了在小儿专科医院和开展小儿外科手术的其他医院实施的非生理性复杂手术（即 2015 年安大略省医疗保险计划福利表中 ≤ 7 个基本单位）的发生率。我们使用 Yue 和 Clayton 指数和有效共同手术数量（Herfindahl 指数的倒数）来量化这两种医院类型开展的小儿外科手术的相似性和多样性。

结果

在 8 年的研究期间，在安大略省的 158 家医院共实施了 830830 例小儿外科手术。与其他医院相比，在开展小儿外科手术的医院中，大多数手术操作是非生理性复杂的（50%，P<0.001）。小儿专科医院非生理性复杂手术的发生率逐年递增，而其他医院则呈相反趋势。与其他医院相比，小儿专科医院非生理性复杂手术的平均相似性指数较低（0.52；95%置信区间[CI]，0.51 至 0.54）。小儿专科医院的非生理性复杂手术的平均共同手术数量（即多样性）高于开展小儿外科手术的其他 154 家医院（分别为 65.3 例和 21.8 例；平均差异，43.5；95%CI，42.2 至 44.8；P<0.001）。