Köckerling F, Schwab R, Zarras K, Lammers B, Adolf D, Stechemesser B, Mayer F, Reinpold W, Niebuhr H, Riediger H
Hernia Center, Vivantes Humboldt Hospital, Academic Teaching Hospital of Charité, University Medicine, Am Nordgraben 2, 13509, Berlin, Germany.
Department of General, Visceral and Thoracic Surgery, German Armed Forces Central Hospital Koblenz, Rübenacher Str. 170, 56072, Koblenz, Germany.
Langenbecks Arch Surg. 2025 Aug 13;410(1):244. doi: 10.1007/s00423-025-03836-z.
There is an ongoing controversal debate about whether the hospital volume (hospital case load) or the surgeon volume has a greater influence on outcome. The implications of high surgeon volume for the outcome have been demonstrated for ventral and incisional hernia repair. This analysis of data from the Herniamed Registry now aims to assess the relationship between hospital volume/hospital case load and outcome in incisional hernia repair.
To calculate the caseload all repairs carried out in the centers and which met the inclusion criteria were included. The annualized number (based on the time difference between the first and last entry for the respective center) of repairs per center was used for the following categories: < = 20 procedures per year, > 20 - < = 40 procedures per year, > 40 procedures per year. The association of confirmatory defined patient- and procedure-related characteristics to the outcome parameters (general, intraoperative and postoperative surgical complications, complication-related reoperations as well as recurrences, pain at rest, pain on exertion, and chronic pain requiring treatment on 1-year follow-up) was analyzed using logistic regression models.
Following patient selection, 55,584 patients were included in analysis of the relation of the hospital volume as well as of other potential confounders to the outcome parameters. In the caseload group with ≤ 20 incisional hernias per year, the mean number of surgeons was 6.8, whereas in the caseload group > 20 - ≤ 40 per year the mean number was 12.9 surgeons and in the caseload group > 40 incisional hernias per year, the mean number was 23.7 surgeons. The multivariable analysis of the data from the Herniamed Registry demonstrates that a lower case load is associated with a higher risk of postoperative surgical complications and recurrences, but with a lower risk of pain at rest, pain on exertion and chronic pain requiring treatment.
In summary, this analysis of data from the Herniamed Registry demonstrates that a relatively large number of surgeons are involved in the repair of incisional hernias, regardless of the hospital caseload. High hospital volume comes with a price of more surgeons participating resulting in higher postoperative surgical complication and recurrence risk. Low-volume centers seem to manage less severe cases, whereas high-volume centers appear to act as referral centers, treating more complex cases, which might reflect influence of unobserved confounders.
关于医院手术量（医院病例数）还是外科医生手术量对手术结果有更大影响，目前存在争议。高外科医生手术量对腹侧和切口疝修补术结果的影响已得到证实。对来自Herniamed注册中心的数据进行的这项分析旨在评估医院手术量/医院病例数与切口疝修补术结果之间的关系。
为计算病例数，纳入了各中心进行的且符合纳入标准的所有修补手术。每个中心的年手术量（基于各中心首次和最后一次记录的时间差）用于以下类别：每年≤20例手术、每年>20 - ≤40例手术、每年>40例手术。使用逻辑回归模型分析已确定的与患者和手术相关的特征与结果参数（一般、术中及术后手术并发症、与并发症相关的再次手术以及复发、静息痛、活动痛和随访1年时需要治疗的慢性疼痛）之间的关联。
经过患者筛选，55584例患者被纳入分析医院手术量以及其他潜在混杂因素与结果参数之间的关系。在每年≤20例切口疝的病例数组中，外科医生的平均人数为6.8人，而在每年>20 - ≤40例的病例数组中，平均人数为12.9名外科医生，在每年>40例切口疝的病例数组中，平均人数为23.7名外科医生。对Herniamed注册中心数据的多变量分析表明，较低的病例数与术后手术并发症和复发的较高风险相关，但与静息痛、活动痛和需要治疗的慢性疼痛的较低风险相关。
总之，对Herniamed注册中心数据的这项分析表明，无论医院病例数多少，都有相对较多的外科医生参与切口疝修补术。高医院手术量伴随着更多外科医生参与的代价，导致术后手术并发症和复发风险更高。低手术量中心似乎处理病情较轻的病例，而高手术量中心似乎充当转诊中心，治疗更复杂的病例，这可能反映了未观察到的混杂因素的影响。
