Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Japan.
Department of Health Policy and Informatics, Tokyo Medical and Dental University, Japan.
Surgery. 2019 Dec;166(6):1105-1110. doi: 10.1016/j.surg.2019.06.002. Epub 2019 Jul 25.
The relationship between hospital case volume and in-hospital mortality, often referred to as the volume-outcome relationship, has been studied in various types of surgery. Despite its usefulness in policymaking, it has not been reported in operative trauma surgery. This study aimed to identify the volume-outcome relationship in severe operative trauma surgery.
A retrospective cohort study was conducted using a risk adjustment method based on the International Classification of Diseases 10th Revision Codes in a Japanese nationwide administrative database. Patients discharged from July 1, 2010, to March 31, 2015, who underwent severe operative trauma surgery, defined as having a mortality rate equal to or greater than 10%, were included. A logistic regression model with random effects was used for analysis. Annual hospital case volume was categorized into 4 groups: <6 (reference group), 6 to 11, 12 to 17, and ≥18. Subgroup analysis on head and torso trauma surgery was conducted.
The study population consisted of 18,382 patients from 964 hospitals. Overall mortality was 19.7%. The adjusted odds ratio for mortality did not reduce significantly in the higher hospital case volume category. Subgroup analysis revealed that the adjusted odds ratio reduced significantly in the subgroup of torso surgery (<6 cases/y [reference] vs ≥6 cases/y; adjusted odds ratio, 0.55; 95% confidence interval, 0.42-0.73), but not in the operative head trauma surgery subgroup.
A volume-outcome relationship was not identified in severe operative trauma surgery but was observed in the operative torso trauma surgery subgroup.
医院病例量与住院死亡率之间的关系，通常称为量效关系，已经在各种类型的手术中进行了研究。尽管它在制定政策方面很有用，但在手术创伤外科中尚未报道。本研究旨在确定严重手术创伤外科中的量效关系。
使用基于国际疾病分类第 10 版代码的风险调整方法，对日本全国行政数据库中的患者进行回顾性队列研究。纳入 2010 年 7 月 1 日至 2015 年 3 月 31 日期间接受严重手术创伤手术（定义为死亡率等于或大于 10%）的患者。使用具有随机效应的逻辑回归模型进行分析。将年度医院病例量分为 4 组：<6（参考组）、6-11、12-17 和≥18。对头部和躯干创伤手术进行了亚组分析。
研究人群包括来自 964 家医院的 18382 名患者。总死亡率为 19.7%。在更高的医院病例量类别中，死亡率的调整比值比没有显著降低。亚组分析显示，在躯干手术亚组中（<6 例/年[参考]与≥6 例/年；调整比值比，0.55；95%置信区间，0.42-0.73），调整比值比显著降低，但在手术性头部创伤手术亚组中则没有。
在严重手术创伤外科中未发现量效关系，但在手术性躯干创伤外科亚组中观察到了量效关系。
