Hierarchical multilevel analysis of increased caseload volume and postoperative outcome after elective colorectal surgery
Hierarchical multilevel analysis of increased caseload volume and postoperative outcome after elective colorectal surgery
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DOI：
10.1002/bjs.9264
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发表时间：
2013-10-01
影响因子：
9.6
通讯作者：
Faiz, O. D.
中科院分区：
文献类型：
--
作者：
Burns, E. M.;Bottle, A.;Faiz, O. D.
背景：本研究旨在利用多层次层次分析探讨外科医生和机构数量对英国结直肠手术后预后的影响。方法：采用观察性研究设计。所有在2000年至2008年间接受原发性择期结肠直肠切除术的患者均纳入医院事件统计数据库。顾问外科医生和医院根据其平均每年结肠直肠癌切除病例量分为低、中、高三组。检查的结果指标为术后30天死亡率、28天再入院和再手术以及住院时间。分层多元回归分析校正了年龄、性别、合并症、社会剥夺、手术年份、手术类型和手术入路等因素。结果：共纳入109 261例择期结直肠癌切除术。大规模咨询外科医生和医院的定义分别是每年实施超过20.7和103.5例选择性结直肠癌手术。在整个研究期间，咨询医生和医院手术数量增加。在层次回归模型中，更大的外科医生和机构数量独立预测住院时间较短。较高的供给者数量与术后死亡率、28天再手术率或再入院率之间无统计学关联。结论：单纯增加择期结直肠癌病例量可能有边际的术后获益。
Background: The study aimed to explore the impact of surgeon and institution volume on outcome following colorectal surgery in England using multilevel hierarchical analysis.Methods: An observational study design was used. All patients undergoing primary elective colorectal resection between 2000 and 2008 were included from the Hospital Episode Statistics database. Consultant surgeons and hospitals were divided into tertiles (low, medium and high volume) according to their mean annual colorectal cancer resection caseload. Outcome measures examined were postoperative 30-day mortality, 28-day readmission and reoperation, and length of stay. Hierarchical multiple regression analysis adjusted for age, sex, co-morbidity, social deprivation, year of surgery, operation type and surgical approach.Results: A total of 109 261 elective cancer colorectal resections were included. High-volume consultant surgeons and hospitals were defined as performing more than 20.7 and 103.5 elective colorectal cancer procedures per year respectively. Consultant and hospital operative volumes increased throughout the study period. In hierarchical regression models, greater surgeon and institutional volume independently predicted only shorter length of hospital stay. No statistical association was observed between higher provider volume and postoperative mortality, 28-day reoperation or readmission rates.Conclusion: Increasing elective colorectal cancer caseload alone may have marginal postoperative benefit.