Hip Fracture Outcomes: Does Surgeon or Hospital Volume Really Matter?
Hip Fracture Outcomes: Does Surgeon or Hospital Volume Really Matter?
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DOI：
10.1097/ta.0b013e31816166bb
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发表时间：
2009-03-01
影响因子：
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通讯作者：
Olson, Steven A.
中科院分区：
文献类型：
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作者：
Browne, James A.;Pietrobon, Ricardo;Olson, Steven A.
背景：目前关于外科医生和医院容量与髋部骨折术后患者预后之间关系的数据尚无定论。我们假设，通过减少术后并发症和死亡率、缩短住院时间、出院时患者的常规处理和降低护理成本，接受髋部骨折护理的外科医生和医院的治疗效果更好。方法：这是一项使用全国住院病人样本数据库的回顾性队列研究。从1988年到2002年，97,894例髋部骨折手术患者的数据被提取出来。使用多元线性回归模型来估计外科医生和医院容积与股骨颈和股骨粗隆部骨折护理结果之间的校正相关性。结果：采用小容量外科手术固定髋部骨折患者的住院死亡率（15例/年）（p = 0.005）。输血、肺炎和褥疮溃疡的发生率在由小容量外科医生处理的患者中也较高(p =
Background: Current data on the association between surgeon and hospital volumes and patient outcomes after hip fracture surgery is inconclusive. We hypothesized that surgeons and hospitals with higher caseloads of hip fracture care have better outcomes as measured by decreased postoperative complications and mortality, shorter length of stay in the hospital, routine disposition of patients on discharge, and decreased cost of care.Methods: This is a retrospective cohort study using the Nationwide Inpatient Sample database. Data were extracted on 97,894 patients surgically treated for a hip fracture for the years 1988 through 2002. Multiple linear regression models were used to estimate the adjusted association between surgeon and hospital volume and outcomes for femoral neck and pertrochanteric hip fracture care.Results: The in-hospital mortality rate for those patients who had hip fracture fixation by a low-volume surgeon (15 cases/yr) (p = 0.005). The incidence of transfusion, pneumonia, and decubitus ulcer were also higher in those patients managed by a low-volume surgeon (p =