Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at, Würzburg University Hospital, Würzburg, Germany.
Department of Thoracic Surgery, Thoraxklinik at Heidelberg University Hospital, Heidelberg, Germany.
Int J Colorectal Dis. 2023 Jul 31;38(1):203. doi: 10.1007/s00384-023-04495-6.
A correlation between the hospital volume and outcome is described for multiple entities of oncological surgery. To date, this has not been analyzed for the surgical treatment of sigmoid diverticulitis. The aim of this study was to explore the impact of the annual caseload per hospital of colon resection on the postoperative incidence of complications, failure to rescue, and mortality in patients with diverticulitis.
Patients receiving colorectal resection independent from the diagnosis from 2012 to 2017 were selected from a German nationwide administrative dataset. The hospitals were grouped into five equal caseload quintiles (Q1-Q5 in ascending caseload order). The outcome analysis was focused on patients receiving surgery for sigmoid diverticulitis.
In total, 662,706 left-sided colon resections were recorded between 2012 and 2017. Of these, 156,462 resections were performed due to sigmoid diverticulitis and were included in the analysis. The overall in-house mortality rate was 3.5%, ranging from 3.8% in Q1 (mean of 9.5 procedures per year) to 3.1% in Q5 (mean 62.8 procedures per year; p < 0.001). Q5 hospitals revealed a risk-adjusted odds ratio of 0.85 (95% CI 0.78-0.94; p < 0.001) for in-hospital mortality compared to Q1 during multivariable logistic regression analysis. High-volume centers showed overall lower complication rates, whereas the failure-to-rescue did not differ significantly.
Surgical treatment of sigmoid diverticulitis in high-volume colorectal centers shows lower postoperative mortality rates and fewer postoperative complications.
描述了多种肿瘤外科手术与医院容量之间的相关性。迄今为止，对于乙状结肠憩室炎的手术治疗，尚未对此进行分析。本研究旨在探讨医院每年每例结肠切除术的病例数对憩室炎患者术后并发症、抢救失败和死亡率的影响。
从德国国家行政数据集选择 2012 年至 2017 年接受与诊断无关的结直肠切除术的患者。将医院分为五组，每组病例数相等（按病例数升序排列为 Q1-Q5）。结果分析侧重于因乙状结肠憩室炎而行手术的患者。
2012 年至 2017 年期间共记录了 662706 例左侧结肠切除术。其中，156462 例因乙状结肠憩室炎而行切除术，并纳入分析。总体院内死亡率为 3.5%，范围从 Q1 的 3.8%（每年平均 9.5 例）到 Q5 的 3.1%（每年平均 62.8 例；p<0.001）。多变量逻辑回归分析显示，与 Q1 相比，Q5 医院的风险调整比值比为 0.85（95%CI 0.78-0.94；p<0.001）。高容量中心总体显示出较低的并发症发生率，而抢救失败没有显著差异。
在高容量结直肠中心进行乙状结肠憩室炎的手术治疗显示出较低的术后死亡率和较少的术后并发症。
