Department of Surgery, Ocala Regional Medical Center, Ocala, FL, USA.
Fred Hutchinson Cancer Research Center, Seattle, WA, USA.
Am Surg. 2023 Apr;89(4):996-1002. doi: 10.1177/00031348211049251. Epub 2021 Nov 11.
Previous investigations have shown a positive association between hospital volume of operations and clinical outcomes. However, it is unclear whether such relationships also apply to emergency surgery. We sought to examine the association between hospital case volume and inpatient mortality for 7 common emergency general surgery (EGS) operations among geriatric patients.
This is a population based retrospective cohort study using the Centers of Medicare and Medicaid Services (CMS) Limited Dataset Files (LDS) from 2011 to 2013. The 7 most common emergency surgeries included (1) partial colectomy, (2) small-bowel resection (SBR), (3) cholecystectomy, (4) appendectomy, (5) lysis of adhesions (LOA), (6) operative management of peptic ulcer disease (PUD), and (7) laparotomy with the primary outcome being inpatient mortality. Risk-adjusted inpatient mortality was plotted against operative volume. Subsequently an operative volume threshold was calculated using a best fit regression method. Based on these estimates, high- and low-volume hospitals were compared to examine significance of outcomes. Significance was defined as -value < .05.
The final cohort comprised of 414 779 patients from 3994 hospitals. The standardized mortality ratio (SMR) for high-volume centers were lower in 6 out of 8 surgeries examined. Small-bowel resection and partial colectomy operations had a significant decrease in mortality based on a volume threshold.
We observed decreased mortality with higher surgical volume for small-bowel resection and partial colectomy operations. Such differences may be related to practice patterns during the perioperative period, as complications related to the perioperative care were significantly lower for high-volume centers.
先前的研究表明，医院手术量与临床结果之间存在正相关关系。然而，目前尚不清楚这种关系是否也适用于急诊手术。我们旨在研究老年患者 7 种常见的急诊普通外科（EGS）手术的医院病例量与住院患者死亡率之间的关系。
这是一项基于人群的回顾性队列研究，使用了 2011 年至 2013 年医疗保险和医疗补助服务中心（CMS）的有限数据集文件（LDS）。7 种最常见的急诊手术包括：（1）部分结肠切除术，（2）小肠切除术（SBR），（3）胆囊切除术，（4）阑尾切除术，（5）粘连松解术（LOA），（6）消化性溃疡病的手术治疗，（7）剖腹术，主要结局为住院患者死亡率。将风险调整后的住院死亡率与手术量进行了绘制。随后，使用最佳拟合回归方法计算了手术量阈值。基于这些估计值，将高、低容量医院进行了比较，以检查结果的显著性。显著性定义为 P 值 <.05。
最终队列包括来自 3994 家医院的 414779 名患者。在 8 种手术中的 6 种手术中，高容量中心的标准化死亡率（SMR）较低。小肠切除术和部分结肠切除术的手术量达到一定阈值后，死亡率显著下降。
我们观察到小肠切除术和部分结肠切除术的手术量增加与死亡率降低有关。这些差异可能与围手术期的实践模式有关，因为高容量中心的围手术期相关并发症明显较低。
