Department of Anesthesiology and Perioperative Medicine, Henan Provincial People's Hospital, People's Hospital of Zhengzhou University, Zhengzhou, Henan, China.
Graduate Institute of Business Administration, College of Management, Fu Jen Catholic University, Taipei, Taiwan.
Eur J Pediatr. 2024 Feb;183(2):619-628. doi: 10.1007/s00431-023-05308-2. Epub 2023 Nov 9.
This study aimed to examine the association between hospital volume and postoperative outcomes in pediatric major surgery using a nationwide database. The study included pediatric patients who underwent first major elective inpatient surgery and hospitalization for more than 1 day. The results showed no significant difference in the risk of 30-day postoperative mortality based on hospital volume. However, patients in the middle- and high-volume groups had significantly lower rates of 30-day major complications, particularly deep wound infection. In terms of 90-day postoperative outcomes, patients in the high-volume group had a significantly lower risk of mortality and lower rates of major complications, particularly deep wound infection, pneumonia, and septicemia. Conclusions: The study suggests that pediatric patients undergoing major surgery in high and middle-volume groups have better outcomes in terms of major complications compared to the low-volume group. What is Known: • Limited evidence exists on the connection between hospital volume and pediatric surgery outcomes. What is New: • A Taiwan-based study, using national data, found that high and middle hospital-volume groups experienced significantly lower rates of major complications within 30 and 90 days after surgery. • High-volume hospitals demonstrated a substantial decrease in the risk of 90-day postoperative mortality. • The study underscores the importance of specialized pediatric surgical centers and advocates for clear guidelines for hospital selection, potentially improving outcomes and informing future health policies.
本研究旨在使用全国性数据库探讨医院容量与儿科重大手术术后结局之间的关联。研究纳入了接受首次主要择期住院手术且住院时间超过 1 天的儿科患者。研究结果显示，医院容量与 30 天术后死亡率的风险无显著差异。然而，中高容量组患者 30 天主要并发症（尤其是深部伤口感染）的发生率显著降低。在 90 天术后结局方面，高容量组患者死亡率和主要并发症（尤其是深部伤口感染、肺炎和败血症）的风险显著降低。结论：本研究表明，与低容量组相比，接受重大手术的儿科患者在高容量组和中容量组的主要并发症方面具有更好的结局。已知情况：• 现有关于医院容量与儿科手术结局之间联系的证据有限。新情况：• 一项基于台湾的研究使用全国数据发现，高容量组和中容量组患者在术后 30 天和 90 天内主要并发症的发生率显著降低。• 高容量医院在 90 天术后死亡率的风险降低方面表现出显著优势。• 该研究强调了专门的儿科手术中心的重要性，并主张为医院选择制定明确的指导方针，这可能会改善结局并为未来的卫生政策提供信息。
