633rd Medical Group, Joint Base Langley-Eustis, Hampton, VA.
Clinical Investigation Department.
J Minim Invasive Gynecol. 2018 Jul-Aug;25(5):855-860. doi: 10.1016/j.jmig.2018.01.001. Epub 2018 Jan 11.
To compare 12-month postoperative complication rates in women who underwent sling procedures by high-volume versus low-volume surgeons at US military treatment facilities (MTFs).
Retrospective cohort study (Canadian Task Force classification II-2).
US MTFs.
Female military beneficiaries enrolled in TRICARE.
Sling surgery for stress urinary incontinence between January 1, 2011 and December 31, 2012.
The primary exposure was surgeon volume (high vs low). Surgeon volume was categorized as high or low based on the number of slings performed in the previous 2 years at US MTFs (January 1, 2009 to December 31, 2010). The primary outcome was a composite variable indicating at least 1 postoperative complication within 12 months. We used International Classification of Diseases, 9th revision and Current Procedural Terminology codes to identify postoperative complications that occurred in the 12 months after the index sling procedure. During the study period 348 gynecologic and urologic surgeons performed 1632 slings. The average patient age was 47.2 years. Based on our data distribution we classified surgeons as high volume (>12 slings/2 years) or low volume (<4 slings/2 years). High-volume surgeons operated on patients who were older, more likely to have comorbidities, and more likely to receive concomitant prolapse surgery. Using a cluster analysis the overall likelihood of at least 1 postoperative complication in 12 months for high-volume versus low-volume surgeons was 48.4% versus 42.2% (adjusted odds ratio, 1.24; 95% confidence interval, .99-1.54; p = .06). There were no differences between high- and low-volume surgeons in the rate of almost all other postoperative complications.
No significant differences in 12-month complication rates after sling surgery, stratified by surgeon volume, were seen in a setting of overall low-volume military surgeons.
比较美国军事治疗设施（MTF）中高容量和低容量外科医生行吊带手术的女性患者术后 12 个月并发症发生率。
回顾性队列研究（加拿大任务组分类 II-2）。
美国 MTF。
在 TRICARE 登记的女性军事受益方。
2011 年 1 月 1 日至 2012 年 12 月 31 日期间行吊带术治疗压力性尿失禁。
主要暴露因素为外科医生手术量（高或低）。根据 2009 年 1 月 1 日至 2010 年 12 月 31 日在 MTF 进行的吊带数量，将外科医生手术量分为高或低（高或低）。主要结果是术后 12 个月内至少发生 1 种术后并发症的复合变量。我们使用国际疾病分类，第 9 版和当前程序术语代码来确定索引吊带手术后 12 个月内发生的术后并发症。在研究期间，有 348 名妇科和泌尿科医生进行了 1632 例吊带手术。患者平均年龄为 47.2 岁。根据我们的数据分布，我们将外科医生分为高容量（> 12 例/ 2 年）或低容量（<4 例/ 2 年）。高容量外科医生治疗的患者年龄较大，合并症更多，更可能同时行脱垂手术。使用聚类分析，高容量外科医生与低容量外科医生相比，术后 12 个月至少发生 1 种并发症的总体可能性为 48.4%比 42.2%（调整后的优势比，1.24；95%置信区间，0.99-1.54；p=0.06）。高容量和低容量外科医生在几乎所有其他术后并发症的发生率方面没有差异。
在整体低容量军事外科医生的环境中，按外科医生手术量分层后，吊带手术后 12 个月的并发症发生率没有显著差异。
