Lee Daniel J, Kim Chungah, Asghar Mauz, Lee John M, Kantarevic Jasmin, Sibley Lyn M, Chan Yvonne
Division of Rhinology, Department of Otolaryngology - Head & Neck Surgery, Unity Health Toronto - St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
Division of Otolaryngology - Head & Neck Surgery, Department of Surgery, North York General Hospital, University of Toronto, Toronto, Ontario, Canada.
Int Forum Allergy Rhinol. 2025 Sep;15(9):966-973. doi: 10.1002/alr.23602. Epub 2025 May 6.
Previous studies have demonstrated a positive relationship between surgeon volume and patient outcomes. While this relationship has been established in oncologic, bariatric, and orthopedic surgeries, little is known in the realm of endoscopic sinus surgery (ESS). The objective was to assess the association between a surgeon's ESS annual volume and rates of revision surgery within 5 years as well as 30-day complications for patients with chronic rhinosinusitis (CRS).
We identified CRS patients in Ontario, Canada, who underwent primary ESS, using surgeon-level administrative data between 2014 and 2018 (N = 13,562). Surgeon volume was calculated based on the number of procedures performed in the previous year by the surgeon and was divided into quartiles. We identified those who underwent revision ESS within the subsequent 5-year period. Complications were defined as unplanned hospital admission or emergency department visit within the first 30 days following the operation. A multivariate regression model was used to estimate the effect of surgeon volume on revision rate.
An unadjusted model demonstrated that high surgeon volume quartile (> 63/year) was associated with lower rates of revision surgery and 30-day hospitalization (p < 0.05 for both) along with a higher rate of complete ESS (p < 0.001). After controlling for patient/surgeon covariates and extent of ESS, low-volume surgeons (1-17/year) remained an independent statistically significant predictor of revision surgery (hazard ratios [HR]: 1.60, 95% confidence interval [CI]: 1.17-2.19).
Our study is the first to demonstrate a surgeon volume-outcome relationship in ESS. Being a high-volume surgeon is predictive of a lower revision rate in CRS patients undergoing ESS.
先前的研究表明外科医生的手术量与患者预后之间存在正相关关系。虽然这种关系已在肿瘤、减肥和骨科手术中得到证实，但在内镜鼻窦手术（ESS）领域却知之甚少。目的是评估外科医生的年度ESS手术量与慢性鼻窦炎（CRS）患者5年内的翻修手术率以及30天并发症之间的关联。
我们利用2014年至2018年外科医生层面的行政数据，在加拿大安大略省识别出接受初次ESS的CRS患者（N = 13,562）。根据外科医生上一年进行的手术数量计算手术量，并将其分为四分位数。我们确定了在随后5年内接受ESS翻修手术的患者。并发症定义为术后前30天内计划外住院或急诊就诊。使用多变量回归模型来估计手术量对外科翻修率的影响。
一个未调整的模型表明，高手术量四分位数（> 63/年）与较低的翻修手术率和30天住院率相关（两者p < 0.05），同时完全ESS率较高（p < 0.001）。在控制了患者/外科医生协变量和ESS范围后，低手术量外科医生（1 - 17/年）仍然是翻修手术的一个独立的统计学显著预测因素（风险比[HR]：1.60，95%置信区间[CI]：1.17 - 2.19）。
我们的研究首次证明了ESS中外科医生手术量与预后的关系。作为一名高手术量外科医生可预测接受ESS的CRS患者较低的翻修率。
