Surgeon volume and operative mortality in the United States
Surgeon volume and operative mortality in the United States
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DOI：
10.1056/nejmsa035205
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发表时间：
2003-11-27
影响因子：
158.5
通讯作者：
Lucas, FL
中科院分区：
文献类型：
--
作者：
Birkmeyer, JD;Stukel, TA;Lucas, FL
背景资料：虽然医院的容量和手术死亡率之间的关系是公认的，对于大多数程序，相对重要性的经验，手术surgeon.Methods：使用信息从国家医疗保险索赔数据库1998年至1999年，我们研究了死亡率在所有474,108例患者接受了8个心血管手术或癌症切除术。采用嵌套回归模型，我们检验了手术死亡率与外科医生数量和医院数量（每项均以每年进行的总手术量为单位）之间的关系，并对患者的特征和提供者的其他特征进行了调整。
Background: Although the relation between hospital volume and surgical mortality is well established, for most procedures, the relative importance of the experience of the operating surgeon is uncertain.Methods: Using information from the national Medicare claims data base for 1998 through 1999, we examined mortality among all 474,108 patients who underwent one of eight cardiovascular procedures or cancer resections. Using nested regression models, we examined the relations between operative mortality and surgeon volume and hospital volume (each in terms of total procedures performed per year), with adjustment for characteristics of the patients and other characteristics of the providers.Results: Surgeon volume was inversely related to operative mortality for all eight procedures (P=0.003 for lung resection, P