Rotterdam and Hilversum, The Netherlands; and Rochester, Minn.
From the Departments of Plastic, Reconstructive and Hand Surgery, and Rehabilitation, Erasmus Medical Center, Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic, Hilversum; and the Biomechanics Laboratory and Tendon and Soft Tissue Biology Laboratory, Division of Orthopedic Research, Mayo Clinic.
Plast Reconstr Surg. 2018 Jun;141(6):1439-1446. doi: 10.1097/PRS.0000000000004369.
Although previous studies have shown that more experienced surgeons have better patient outcomes following a variety of procedures, in hand surgery and carpal tunnel release in particular, this relation remains unproven. The authors assessed whether there is an association between surgeon volume and patient outcomes following open carpal tunnel release.
Patients who underwent carpal tunnel release between 2011 and 2015 at outpatient hand surgery clinics in The Netherlands were included. Surgeon annual volume was defined as the average number of carpal tunnel releases performed per year per participating surgeon over the study period. Primary outcome measures were the Symptom Severity Scale and Functional Status Scale of the Boston Carpal Tunnel Questionnaire 6 months postoperatively. Multilevel random intercept linear regression analyses were performed to assess whether there was an association between surgeon annual volume and outcome measures, with adjustment for patient characteristics, concomitant procedures, and intake score on the Boston Carpal Tunnel Questionnaire.
A total of 1345 patients were included, operated on by 17 surgeons. Median annual surgeon volume was 75 (interquartile range, 50 to 149). Only 0.5 to 0.6 percent of the total variance in patient outcome on the Boston Carpal Tunnel Questionnaire could be explained by random differences between surgeons. The authors did not find an association between annual surgeon volume and outcome measures 6 months postoperatively (Symptom Severity Scale: β = 0.000; 95 percent CI, -0.001 to 0.001; and Functional Status Scale: β = 0.000; 95 percent CI, -0.001 to 0.001).
In the authors' sample of highly specialized hand surgeons operating in high-volume centers, they found no differences in outcome between high- and low-volume surgeons.
尽管先前的研究表明，在各种手术中，经验丰富的外科医生的患者预后更好，但在手部外科和腕管松解术尤其如此，这一关系尚未得到证实。作者评估了开放腕管松解术后外科医生手术量与患者预后之间是否存在关联。
纳入 2011 年至 2015 年在荷兰门诊手部外科诊所接受腕管松解术的患者。外科医生年手术量定义为每位参与研究的外科医生在研究期间每年平均进行的腕管松解术数量。主要结局测量指标为术后 6 个月的波士顿腕管问卷的症状严重程度量表和功能状态量表。采用多水平随机截距线性回归分析评估外科医生年手术量与结局测量指标之间是否存在关联，并对患者特征、伴随手术以及波士顿腕管问卷的摄入量评分进行调整。
共纳入 1345 例患者，由 17 名外科医生进行手术。中位外科医生年手术量为 75（四分位间距，50 至 149）。患者术后波士顿腕管问卷结果的总方差中只有 0.5%至 0.6%可以通过外科医生之间的随机差异来解释。作者未发现外科医生年手术量与术后 6 个月的结局测量指标之间存在关联（症状严重程度量表：β=0.000；95%置信区间，-0.001 至 0.001；功能状态量表：β=0.000；95%置信区间，-0.001 至 0.001）。
在作者的高容量中心的高度专业化手部外科医生样本中，他们发现高容量和低容量外科医生之间的结局没有差异。
