Hendricks Anne, Diers Johannes, Baum Philip, Weibel Stephanie, Kastner Carolin, Müller Sophie, Lock Johan Friso, Köhler Franziska, Meybohm Patrik, Kranke Peter, Germer Christoph-Thomas, Wiegering Armin
Department of General, Visceral, Transplant, Vascular and Pediatric Surgery University Hospital Würzburg, Oberduerrbacherstrasse 6, 97080, Wuerzburg, Germany.
Department of General, Visceral, Transplant, Vascular and Pediatric Surgery University Hospital Würzburg, Oberduerrbacherstrasse 6, 97080, Wuerzburg, Germany; Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Roentgenstrasse 1, 69126, Heidelberg, Germany.
Int J Surg. 2021 Feb;86:24-31. doi: 10.1016/j.ijsu.2020.12.010. Epub 2021 Jan 9.
In the past, for a number of abdominal surgical interventions a correlation between treatment volume of a hospital and the patient's outcome was shown in national and international studies.
Based on a systematic literature search we analyzed the absolute and risk-adjusted in-house lethality as well as the rate of complications and the failure to rescue after abdominal surgery in Germany. The hospitals were grouped in quintiles according to the volume of treatment.
11 studies including more than 2 million patients were identified and surgeries for the treatment of 9 disease conditions were studied. The meta-analysis shows a significantly lower absolute and risk-adjusted in-house mortality for surgery in hospitals with high treatment volumes compared to low volume hospitals. In the context of subgroup analysis, this effect is demonstrated especially for complex surgical procedures. The failure to rescue in patients suffering from sepsis is significantly lower in high volume centers compared to low volume centers.
This systematic review and meta-analysis shows on more than 2 million patients that there is a volume-outcome relationship for the surgical treatment of abdominal diseases in Germany across various organ systems, which is particularly true for complex interventions.
过去，在国内和国际研究中均显示，对于一些腹部外科手术干预措施，医院的治疗量与患者的预后之间存在关联。
基于系统的文献检索，我们分析了德国腹部手术后的院内绝对死亡率和风险调整死亡率，以及并发症发生率和抢救失败率。根据治疗量将医院分为五等份。
共纳入11项研究，涉及超过200万患者，并对9种疾病的手术治疗进行了研究。荟萃分析表明，与低治疗量医院相比，高治疗量医院手术的院内绝对死亡率和风险调整死亡率显著更低。在亚组分析中，这种效应在复杂外科手术中尤为明显。与低治疗量中心相比，高治疗量中心脓毒症患者的抢救失败率显著更低。
这项系统评价和荟萃分析对超过200万患者的研究表明，在德国，各种器官系统腹部疾病的手术治疗存在治疗量-预后关系，这在复杂干预中尤为明显。
