Nishimura Kunihiro, Ogasawara Kuniaki, Kitazono Takanari, Iihara Koji
Department of Preventive Medicine and Epidemiology, National Cerebral and Cardiovascular Center.
Department of Neurosurgery, Iwate Medical University.
Circ J. 2021 Sep 24;85(10):1876-1884. doi: 10.1253/circj.CJ-20-1214. Epub 2021 Aug 13.
The degree of association between mortality and case volume/physician volume is well known for many surgical procedures and medical conditions. However, the link between physician volume and death rate in patients hospitalized for stroke remains unclear. This study analyzed the correlation between in-hospital stroke mortality and physician volume per hospital, considering board certification status.
For this retrospective registry-based cohort study, data were obtained from the Japanese nationwide registry on patients hospitalized for ischemic stroke, intracerebral hemorrhage (ICH), and subarachnoid hemorrhage (SAH) between 2010 and 2016. The number of stroke care physicians and relevant board-certified physicians was also obtained. Odd ratios (ORs) of 30-day in-hospital mortality were estimated after adjusting for institutional and patient differences using generalized mixed logistic regression. From 295,150 (ischemic stroke), 98,657 (ICH), and 36,174 (SAH) patients, 30-day in-hospital mortality rates were 4.4%, 16.0%, and 26.6%, respectively. There was a correlation between case volume and physician volume. A higher number of stroke care physicians was associated with a reduction in 30-day mortality after adjusting for stroke case volume and comorbidities for all stroke types (all P for trend<0.05).
An increased number of stroke care physicians was associated with reduced in-hospital mortality for all types of stroke. The volume threshold of board-certified physicians depends on the specialty and stroke type.
许多外科手术和医疗状况下，死亡率与病例数量/医生数量之间的关联程度已为人熟知。然而，因中风住院患者的医生数量与死亡率之间的联系仍不明确。本研究分析了考虑到委员会认证状态的情况下，每家医院的住院中风死亡率与医生数量之间的相关性。
对于这项基于回顾性登记的队列研究，数据来自日本全国性登记处，涉及2010年至2016年间因缺血性中风、脑出血（ICH）和蛛网膜下腔出血（SAH）住院的患者。还获取了中风护理医生和相关委员会认证医生的数量。使用广义混合逻辑回归在调整机构和患者差异后，估计了30天住院死亡率的比值比（OR）。在295,150例（缺血性中风）、98,657例（ICH）和36,174例（SAH）患者中，30天住院死亡率分别为4.4%、16.0%和26.6%。病例数量与医生数量之间存在相关性。在调整所有中风类型的中风病例数量和合并症后，更多的中风护理医生与30天死亡率的降低相关（所有趋势P值<0.05）。
中风护理医生数量的增加与所有类型中风的住院死亡率降低相关。委员会认证医生的数量阈值取决于专业和中风类型。
