a Department of Public Health , Erasmus University Medical Center , Rotterdam.
b Department of Neurology , Erasmus University Medical Center , Rotterdam.
Acta Orthop. 2019 Feb;90(1):26-32. doi: 10.1080/17453674.2018.1545383.
Background and purpose - It has been hypothesized that hospitals and surgeons with high caseloads of hip fracture patients have better outcomes, but empirical studies have reported contradictory results. This systematic review and meta-analysis evaluates the volume-outcome relationship among patients with hip fracture patients. Methods - A search of different databases was performed up to February 2018. Selection of relevant studies, data extraction, and critical appraisal of the methodological quality was performed by 2 independent reviewers. A random-effects meta-analysis using studies with comparative cut-offs was performed to estimate the effect of hospital and surgeon volume on outcome, defined as in-hospital mortality and postoperative complications. Results - 24 studies comprising 2,023,469 patients were included. Overall, the quality was reasonable. 11 studies reported better health outcomes in high-volume centers and 2 studies reported better health outcomes in low-volume centers. In the meta-analysis of 11 studies there was a statistically non-significant association between higher hospital volume and both lower in-hospital mortality (adjusted odds ratio (aOR) 0.87, 95% confidence interval (CI) 0.73-1.04) and fewer postoperative complications (aOR 0.87, CI 0.75-1.02). Four studies on surgeon volume were included in the meta-analysis and showed a minor association between higher surgeon volume and in-hospital mortality (aOR 0.92, CI 0.76-1.12). Interpretation - This systematic review and meta-analysis did not find an evident effect of hospital or surgeon volume on health outcomes. Future research without volume cut-offs is needed to examine whether a true volume-outcome relationship exists.
背景与目的-有人假设髋部骨折患者的住院人数和手术医生较多的医院和手术医生的治疗效果更好，但实证研究结果却相互矛盾。本系统评价和荟萃分析评估了髋部骨折患者的病例量与治疗效果之间的关系。方法-对截至 2018 年 2 月的不同数据库进行了检索。两名独立评审员对相关研究进行选择、数据提取和方法学质量进行评价。使用具有比较截止值的研究进行随机效应荟萃分析，以评估医院和手术医生的数量对住院死亡率和术后并发症等治疗效果的影响。结果-共纳入 24 项研究，包括 2023469 名患者。总体而言，研究质量良好。11 项研究报告了高容量中心的治疗效果更好，2 项研究报告了低容量中心的治疗效果更好。对 11 项研究进行荟萃分析，发现医院容量越高，住院死亡率越低（校正比值比（aOR）0.87，95%置信区间（CI）0.73-1.04），术后并发症越少（aOR 0.87，CI 0.75-1.02），但差异无统计学意义。纳入 4 项关于手术医生数量的研究进行荟萃分析，结果显示手术医生数量越高，住院死亡率越低（aOR 0.92，CI 0.76-1.12），但差异也无统计学意义。解释-本系统评价和荟萃分析未发现医院或手术医生数量对治疗效果有明显影响。需要进行没有病例量截止值的未来研究，以检查是否存在真正的病例量与治疗效果之间的关系。
