Departments of Obstetrics and Gynecology and Medicine and the Herbert Irving Comprehensive Cancer Center, Columbia University College of Physicians and Surgeons, the Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, and New York Presbyterian Hospital, New York, New York.
Obstet Gynecol. 2018 Jun;131(6):981-990. doi: 10.1097/AOG.0000000000002597.
To perform a population-based analysis to first examine the changes in surgeon and hospital procedural volume for hysterectomy over time and then to explore the association between very low surgeon procedural volume and outcomes.
All women who underwent hysterectomy in New York State from 2000 to 2014 were examined. Surgeons were classified based on the average annual procedural volume as very low-volume surgeons if they performed one procedure per year. We used multivariable models to examine the association between very low-volume surgeon status and morbidity, mortality, transfusion, length of stay, and cost.
Among 434,125 women who underwent hysterectomy, very low-volume surgeons accounted for 3,197 (41.0%) of the surgeons performing the procedures and operated on 4,488 (1.0%) of the patients. The overall complication rates were 32.0% for patients treated by very low-volume surgeons compared with 9.9% for those treated by other surgeons (P<.001) (adjusted relative risk 1.97, 95% CI 1.86-2.09). Specifically, the rates of intraoperative (11.3% vs 3.1%), surgical site (15.1% vs 4.1%) and medical complications (19.5% vs 4.8%), and transfusion (38.5% vs 11.8%) were higher for very low-volume compared with higher volume surgeons (P<.001 for all). Patients treated by very low-volume surgeons were also more likely to have a prolonged length of stay (62.0% vs 22.0%) and excessive hospital charges (59.8% vs 24.6%) compared with higher volume surgeons (P<.001 for both). Mortality rate was 2.5% for very low-volume surgeons compared with 0.2% for higher volume surgeons (P<.001) (adjusted relative risk 2.89, 95% CI 2.32-3.61).
A substantial number of surgeons performing hysterectomy are very low-volume surgeons. Performance of hysterectomy by very low-volume surgeons is associated with increased morbidity, mortality, and resource utilization.
首先进行基于人群的分析，以考察随时间推移行子宫切除术的外科医生和医院手术量的变化，然后探讨极低手术量外科医生与结局之间的关系。
研究纳入了 2000 年至 2014 年期间在纽约州接受子宫切除术的所有女性。如果外科医生每年进行一次手术，则根据平均年度手术量将其分类为低手术量外科医生。我们使用多变量模型来检验低手术量外科医生状态与发病率、死亡率、输血、住院时间和费用之间的关联。
在接受子宫切除术的 434125 名女性中，低手术量外科医生占 3197 名（41.0%），共对 4488 名患者（1.0%）进行了手术。接受低手术量外科医生治疗的患者总体并发症发生率为 32.0%，而接受其他外科医生治疗的患者为 9.9%（P<.001）（校正后相对风险为 1.97，95%CI 1.86-2.09）。具体而言，低手术量外科医生术中（11.3%比 3.1%）、手术部位（15.1%比 4.1%）和医疗并发症（19.5%比 4.8%）以及输血（38.5%比 11.8%）的发生率明显更高（所有 P<.001）。与高手术量外科医生相比，接受低手术量外科医生治疗的患者住院时间更长（62.0%比 22.0%），且过度住院费用更高（59.8%比 24.6%）（两者均 P<.001）。低手术量外科医生的死亡率为 2.5%，而高手术量外科医生的死亡率为 0.2%（P<.001）（校正后相对风险为 2.89，95%CI 2.32-3.61）。
大量行子宫切除术的外科医生手术量非常低。低手术量外科医生行子宫切除术与发病率、死亡率和资源利用增加相关。
