Chattha A, Muste J, Patel A
Division of Plastic and Reconstructive Surgery, Beth Israel Deaconess Medical Center, Boston, MA, USA.
Division of Plastic and Reconstructive Surgery, Albany Medical Center, 50 New Scotland Avenue, MC-190, Albany, NY, 12208, USA.
Hernia. 2018 Oct;22(5):793-799. doi: 10.1007/s10029-018-1803-3. Epub 2018 Aug 9.
The objectives of this study are to evaluate the associations between ventral hernia repair procedure volume and patient outcomes, including both clinical and economic outcomes.
The 2014 National Inpatient Sample was queried for patients who underwent elective, open ventral (incisional) hernia repair with or without mesh. Outcomes included occurrence of major or wound-based in-hospital complications, extended length of stay (> 4 days), and increased costs (> $12,816). High-volume hospitals were defined as the 90th percentile of case volume or higher (> 60 cases/year). Multivariate regression was performed to access the outcomes associated with high-volume hospitals.
54,075 patients at 2049 hospitals were retrieved. 41.4 percent of patients were treated at high-volume hospitals. Patients treated at high-volume hospitals were less likely to experience a major complication (OR 0.88; 95% CI 0.82-0.96; p = 0.002) or wound-based complication (OR 0.84; 95% CI 0.76-0.92; p < 0.001). However, in terms of resource utilization, patients treated at high-volume hospitals were more likely to experience an extended length of stay (OR 1.14; 95% CI 1.09-1.12; p < 0.001) and an increase in costs (OR 1.23; 95% CI 1.17-1.29; p < 0.001).
Hospitals that perform a larger number of ventral hernia repairs, despite caring for a more complex patient population, may be associated with better patient outcomes than lower volume hospitals. However, these same high-volume centers demonstrate an extended length of stay and increased costs. Further research is needed to understand the reason for this gap in proper resource utilization in high-volume ventral hernia repair centers.
本研究的目的是评估腹疝修复手术量与患者预后之间的关联，包括临床和经济预后。
查询2014年全国住院患者样本，找出接受择期开放性腹（切口）疝修补术（使用或不使用补片）的患者。预后包括发生重大或基于伤口的院内并发症、住院时间延长（>4天）和费用增加（>12,816美元）。高手术量医院定义为病例数处于第90百分位数或更高（>60例/年）的医院。进行多变量回归以评估与高手术量医院相关的预后。
从2049家医院中检索出54,075例患者。41.4%的患者在高手术量医院接受治疗。在高手术量医院接受治疗的患者发生重大并发症（OR 0.88；95%CI 0.82 - 0.96；p = 0.002）或基于伤口的并发症（OR 0.84；95%CI 0.76 - 0.92；p < 0.001）的可能性较小。然而，在资源利用方面，在高手术量医院接受治疗的患者住院时间延长（OR 1.14；95%CI 1.09 - 1.12；p < 0.001）和费用增加（OR 1.23；95%CI 1.17 - 1.29；p < 0.001）的可能性更大。
尽管治疗的患者群体更复杂，但进行更多腹疝修复手术的医院可能比手术量较低的医院有更好的患者预后。然而，这些高手术量中心显示住院时间延长和费用增加。需要进一步研究以了解高手术量腹疝修复中心在合理资源利用方面存在这种差距的原因。
