Bucknor Alexandra, Chattha Anmol, Wu Winona, Egeler Sabine, Ultee Klaas, Afshar Salim, Lin Samuel J
Ann Plast Surg. 2018 Apr;80(4 Suppl 4):S174-S177. doi: 10.1097/SAP.0000000000001388.
Centralization of specialist services, including cleft service delivery, is occurring worldwide with the aim of improving the outcomes. This study examines the relationship between hospital surgical volume in cleft palate repair and outcomes.
A retrospective analysis of the Kids' Inpatient Database was undertaken. Children 3 years or younger undergoing cleft palate repair in 2012 were identified. Hospital volume was categorized by cases per year as low volume (LV; 0-14), intermediate volume (IV; 15-46), or high volume (HV; 47-99); differences in complications, hospital costs, and length of stay (LOS) were determined by hospital volume.
Data for 2389 children were retrieved: 24.9% (n = 595) were LV, 50.1% (n = 1196) were IV, and 25.0% (n = 596) were HV. High-volume centers were more frequently located in the West (71.9%) compared with LV (19.9%) or IV (24.5%) centers (P < 0.001 for hospital region). Median household income was more commonly highest quartile in HV centers compared with IV or LV centers (32.3% vs 21.7% vs 18.1%, P < 0.001). There was no difference in complications between different volume centers (P = 0.74). Compared with HV centers, there was a significant decrease in mean costs for LV centers ($9682 vs $,378, P < 0.001) but no significant difference in cost for IV centers ($9260 vs $9682, P = 0.103). Both IV and LV centers had a significantly greater LOS when compared with HV centers (1.97 vs 2.10 vs 1.74, P < 0.001).
Despite improvement in LOS in HV centers, we did not find a reduction in cost in HV centers. Further research is needed with analysis of outpatient, long-term outcomes to ensure widespread cost-efficiency.
包括腭裂治疗服务在内的专科服务集中化正在全球范围内展开，目的是改善治疗效果。本研究探讨腭裂修复手术量与治疗效果之间的关系。
对儿童住院数据库进行回顾性分析。确定2012年接受腭裂修复手术的3岁及以下儿童。医院手术量按每年病例数分为低手术量（LV；0 - 14例）、中等手术量（IV；15 - 46例）或高手术量（HV；47 - 99例）；根据医院手术量确定并发症、住院费用和住院时间（LOS）的差异。
检索到2389名儿童的数据：24.9%（n = 595）为低手术量，50.1%（n = 1196）为中等手术量，25.0%（n = 596）为高手术量。与低手术量（19.9%）或中等手术量（24.5%）中心相比，高手术量中心更多位于西部（71.9%）（医院地区，P < 0.001）。与中等手术量或低手术量中心相比，高手术量中心家庭收入中位数更常见于最高四分位数（32.3%对21.7%对18.1%，P < 0.001）。不同手术量中心之间并发症无差异（P = 0.74）。与高手术量中心相比，低手术量中心平均费用显著降低（9682美元对9378美元，P < 0.001），但中等手术量中心费用无显著差异（9260美元对9682美元，P = 0.103）。与高手术量中心相比，中等手术量和低手术量中心住院时间均显著更长（1.97对2.10对1.74，P < 0.001）。
尽管高手术量中心住院时间有所改善，但我们未发现高手术量中心成本降低。需要进一步研究分析门诊和长期治疗效果，以确保广泛的成本效益。
