Getting It Right First Time program, National Health Service England and National Health Service Improvement, London, United Kingdom.
University College London Hospitals, National Health Service Foundation Trust, London, United Kingdom.
JAMA Surg. 2022 Jul 1;157(7):581-588. doi: 10.1001/jamasurg.2022.1353.
Previous studies have suggested an association between surgical volume and patient outcomes for parathyroid surgery. However, most previous studies are relatively small and the literature is dominated by studies form the US, which might not be readily generalizable to other settings.
To investigate volume-outcome associations for parathyroid surgery in England.
DESIGN, SETTING, AND PARTICIPANTS: Cohort study that included all National Health Service hospital trusts in England with secondary analysis of administrative data using International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10). Participants included all adult, elective hospital admissions for parathyroid surgery without a diagnosis of multiple endocrine neoplasia, parathyroid cancer, or kidney disease over a 5-year period (April 2014-March 2019 inclusive).
The number of procedures conducted in the year prior to the index procedure by each surgeon and each hospital trust.
Repeat parathyroid surgery within 1 year of the index procedure.
This study included data for 17 494 participants who underwent parathyroidectomies conducted across 125 hospital trusts. The median (IQR) age of patients was 62 (53-71) years, and 13 826 were female (79.0%). Across the period, the number of surgeons conducting parathyroid surgery changed little (280 in 2014-2015 and 2018-2019), although the number of procedures conducted rose from 3331 to 3848 per annum. Repeat parathyroid surgery at 1 year was significantly associated with surgeon volume (odds ratio [OR], 0.99; 95% CI, 0.98-0.99), but not trust volume, in the previous 12 months. Extended length of stay (OR, 0.98; 95% CI, 0.98-0.99), hypoparathyroidism/calcium disorder (OR, 1.0; 95% CI, 0.99-1.0), and postprocedural complications (OR, 0.99; 95% CI, 0.99-1.0) were also associated with lower surgeon volume.
In this cohort study, higher surgeon annual volume was associated with decreased rates of repeat parathyroid surgery. A minimum volume threshold of 20 procedures per annum should improve patient outcomes, although possible negative effects on access to services should be monitored.
先前的研究表明甲状旁腺手术的手术量与患者预后之间存在关联。然而，大多数先前的研究规模较小，且文献主要来自美国，这些研究结果可能不易推广到其他环境中。
研究英国甲状旁腺手术的量效关系。
设计、设置和参与者：本队列研究纳入了英格兰所有国民保健服务医院信托机构，使用国际疾病分类第 10 版（ICD-10）对行政数据进行二次分析。参与者包括 5 年内（2014 年 4 月至 2019 年 3 月）所有接受甲状旁腺手术的成年、择期住院患者，无多发性内分泌肿瘤、甲状旁腺癌或肾脏疾病的诊断。
每位外科医生和每家医院信托机构在索引手术前一年进行的手术数量。
索引手术后 1 年内再次进行甲状旁腺手术。
这项研究纳入了 17494 名接受甲状旁腺切除术患者的数据，这些患者来自 125 家医院信托机构。患者的中位（IQR）年龄为 62（53-71）岁，13826 名女性（79.0%）。在此期间，进行甲状旁腺手术的外科医生数量变化不大（2014-2015 年和 2018-2019 年各有 280 名），尽管手术数量从每年 3331 例增加到 3848 例。在过去的 12 个月中，索引手术后 1 年内再次进行甲状旁腺手术与外科医生手术量显著相关（比值比[OR]，0.99；95%CI，0.98-0.99），但与医院手术量无关。住院时间延长（OR，0.98；95%CI，0.98-0.99）、甲状旁腺功能减退/钙代谢紊乱（OR，1.0；95%CI，0.99-1.0）和术后并发症（OR，0.99；95%CI，0.99-1.0）也与外科医生手术量较低有关。
在这项队列研究中，外科医生每年的手术量较高与甲状旁腺手术的再手术率降低有关。每年 20 例的最低手术量阈值应能改善患者的预后，尽管可能对服务的可及性产生负面影响应加以监测。
