SHOULD OPERATIONS BE REGIONALIZED - EMPIRICAL RELATION BETWEEN SURGICAL VOLUME AND MORTALITY
SHOULD OPERATIONS BE REGIONALIZED - EMPIRICAL RELATION BETWEEN SURGICAL VOLUME AND MORTALITY
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DOI：
10.1056/nejm197912203012503
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发表时间：
1979-01-01
影响因子：
158.5
通讯作者：
ENTHOVEN, AC
中科院分区：
文献类型：
--
作者：
LUFT, HS;BUNKER, JP;ENTHOVEN, AC
对1498家医院的12种不同复杂程度的外科手术的死亡率进行了研究，以确定医院的手术量与手术死亡率之间是否存在关系。心脏直视手术、血管外科手术、经尿道前列腺电切术和冠状动脉搭桥术的死亡率随着手术次数的增加而下降。每年进行200例或更多此类手术的医院的死亡率（根据病例组合进行调整）比数量较少的医院低25-41%。对于其他手术，死亡率曲线在较低体积处变平。医院做了50-100例全髋关节置换手术，死亡率几乎与做200例或更多的医院一样低。一些手术，如胆囊切除术，显示体积和死亡率之间没有关系。结果可能反映了数量或经验对死亡率的影响，转介到结果更好的机构，以及一些其他因素，如患者选择。无论如何解释，这些数据都支持区域化对某些行动的价值。
Mortality rates for 12 surgical procedures of varying complexity in 1498 hospitals were examined 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, 25-41% lower than hospitals with lower volumes. For other procedures, the mortality curve flattened at lower volumes. Hospitals doing 50-100 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, referrals to institutions with better outcomes, and a number of other factors, such as patient selection. Regardless of the explanation, these data support the value of regionalization for certain operations.