Schlottmann Francisco, Strassle Paula D, Patti Marco G
Department of Surgery, University of North Carolina at Chapel Hill, 4030 Burnett Womack Building, 101 Manning Drive, CB 7081, Chapel Hill, NC, 27599-7081, USA.
Department of Epidemiology, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
World J Surg. 2018 Jul;42(7):2183-2189. doi: 10.1007/s00268-017-4429-1.
Few studies have analyzed the relationship between surgical volume and outcomes after antireflux procedures. The aim of this study was to determine the effect of surgical volume on postoperative results and costs for patients undergoing surgery for gastroesophageal reflux disease.
We analyzed the National Inpatient Sample (period 2000-2013). Adult patients (≥18 years old) with gastroesophageal reflux disease who underwent fundoplication were included. Hospital surgical volume was determined using the 30th and 60th percentile cut points using weighted discharges and categorized as low (<10 operations/year), intermediate (10-25 operations/year), or high (>25 operations/year). We performed multivariable logistic regression models to assess the effect of surgical volume on patient outcomes.
The studied cohort comprised 75,544 patients who had antireflux surgery. When operations performed at low-volume hospitals, postoperative bleeding, cardiac failure, renal failure, respiratory failure, and inpatient mortality were more common. In intermediate-volume hospitals, patients were more likely to have postoperative infection, esophageal perforation, bleeding, cardiac failure, renal failure, and respiratory failure. The length of hospital stay was longer at low- and intermediate-volume hospitals (1.08 and 0.55 days longer, respectively). There was an increase in charges of 5120 dollars per patient at low-volume centers, and 4010 dollars per patient at intermediate-volume centers.
When antireflux surgery is performed at high-volume hospitals, morbidity is lower, length of hospital stay is shorter, and costs for the healthcare system are decreased.
很少有研究分析抗反流手术后手术量与手术结果之间的关系。本研究的目的是确定手术量对接受胃食管反流病手术患者术后结果和费用的影响。
我们分析了国家住院患者样本（2000 - 2013年期间）。纳入了接受胃底折叠术的成年胃食管反流病患者（≥18岁）。使用加权出院人数的第30和第60百分位数切点确定医院手术量，并将其分为低手术量（<10例手术/年）、中等手术量（10 - 25例手术/年）或高手术量（>25例手术/年）。我们进行了多变量逻辑回归模型以评估手术量对患者结果的影响。
研究队列包括75544例接受抗反流手术的患者。在低手术量医院进行手术时，术后出血、心力衰竭、肾衰竭、呼吸衰竭和住院死亡率更为常见。在中等手术量医院，患者更有可能发生术后感染、食管穿孔、出血、心力衰竭、肾衰竭和呼吸衰竭。低手术量和中等手术量医院的住院时间更长（分别长1.08天和0.55天）。低手术量中心每位患者的费用增加5120美元，中等手术量中心每位患者的费用增加4010美元。
在高手术量医院进行抗反流手术时，发病率较低，住院时间较短，医疗系统成本降低。
