Farber B F, Kaiser D L, Wenzel R P
N Engl J Med. 1981 Jul 23;305(4):200-4. doi: 10.1056/NEJM198107233050405.
We used a statewide program for the surveillance and reporting of infections acquired in the hospital to examine the relation between volume of surgery and the incidence of postoperative wound infection. Over a 29-month period 25,941 surgical procedures performed at 22 hospitals were studied. For all procedures studied, the mean number of operations performed was directly related to hospital size (number of beds). A highly significant inverse relation was found between the logarithm of the frequency of operation and the infection rate for appendectomy, herniorrhaphy, cholecystectomy, colon resection, and abdominal hysterectomy. (The relation was borderline [P = 0.055] for laminectomy and not significant for cesarean section.) Although these data clearly demonstrate higher morbidity in hospitals performing relatively little surgery, there are several possible explanations, and no conclusions for health policy can yet be drawn.
我们利用一个全州范围内监测和报告医院获得性感染的项目，来研究手术量与术后伤口感染发生率之间的关系。在29个月的时间里，对22家医院进行的25941例外科手术进行了研究。对于所有研究的手术，平均手术例数与医院规模（床位数）直接相关。在阑尾切除术、疝修补术、胆囊切除术、结肠切除术和腹式子宫切除术中，发现手术频率的对数与感染率之间存在高度显著的负相关。（椎板切除术的相关性接近临界值[P = 0.055]，剖宫产术则无显著相关性。）尽管这些数据清楚地表明，手术量相对较少的医院发病率较高，但有几种可能的解释，目前还无法得出关于卫生政策的结论。
