Luft H S, Bunker J P, Enthoven A C
N Engl J Med. 1979 Dec 20;301(25):1364-9. doi: 10.1056/NEJM197912203012503.
This study examines mortality rates for 12 surgical procedures of varying complexity in 1498 hospitals to determine whether there is a relation between a hospital's surgical volume and its surgical mortality. The mortality of open-heart surgery, vascular surgery, transurethral resection of the prostate, and coronary bypass decreased with increasing number of operations. Hospitals in which 200 or more of these operations were done annually had death rates, adjusted for case mix, 25 to 41 per cent lower than hospitals with lower volumes. For other procedures, the mortality curve flattened at lower volumes. For example, hospitals doing 50 to 100 total hip replacements attained a mortality rate for this procedure almost as low as that of hospitals doing 200 or more. Some procedures, such as cholecystectomy, showed no relation between volume and mortality. The results may reflect the effect of volume or experience on mortality, or referrals to institutions with better outcomes, as well as a number of other factors, such as patient selection. Regardless of the explanation, these data support the value of regionalization for certain operations.
本研究调查了1498家医院中12种不同复杂程度外科手术的死亡率，以确定医院的手术量与其手术死亡率之间是否存在关联。心脏直视手术、血管手术、经尿道前列腺切除术和冠状动脉搭桥术的死亡率随着手术例数的增加而降低。每年进行200例或更多此类手术的医院，经病例组合调整后的死亡率比手术量较低的医院低25%至41%。对于其他手术，死亡率曲线在手术量较低时趋于平缓。例如，每年进行50至100例全髋关节置换术的医院，该手术的死亡率几乎与每年进行200例或更多此类手术的医院一样低。一些手术，如胆囊切除术，手术量与死亡率之间没有关联。这些结果可能反映了手术量或经验对死亡率的影响，或转诊至疗效更好机构的情况，以及许多其他因素，如患者选择。无论作何解释，这些数据都支持对某些手术进行区域化的价值。
