Does volume matter? The effect of trauma surgeons' caseload on mortality
Does volume matter? The effect of trauma surgeons' caseload on mortality
复制标题
DOI：
10.1097/01.ta.0000063002.12062.21
复制
发表时间：
2003-05-01
影响因子：
--
通讯作者：
Wang, D
中科院分区：
文献类型：
--
作者：
Sava, J;Kennedy, S;Wang, D
背景：。有证据表明，创伤中心治疗数量大的重伤患者比治疗数量少的患者死亡率更低。然而，个体外科医生的创伤工作量对预后的影响尚未被研究。这项研究比较了大容量(HV)创伤外科医生和低容量(LV)创伤外科医生每年治疗较少危重患者的结果。所有在大型I级创伤中心住院的创伤患者在12年期间被分配到HV组或LV组，这取决于他们入院外科医生的年容量。外科医生每年治疗35名严重受伤(创伤严重程度评分15分)的患者被认为是HV。LV组与HV组的可比性检验采用t检验，死亡率比较采用X-2检验。比较了HV和LV外科医生的患者在选择代表中到重度损伤的六种损伤类型时的死亡率。采用TRISS方法(z评分)评估两组患者的治疗效果。TRISS方法在比较创伤结果时的固有偏差被研究患者群体的同质性最小化。共有16,481名患者入院HV外科医生，4,214名患者入院LV外科医生。在所有亚组中，HV和LV患者在年龄、性别、入院时的生理状态、损伤类型和损伤严重程度方面相似。在任何损伤类型中，HV和LV外科医生的死亡率在两组之间没有显著差异。高血压病患者组的z评分为1.88，左室组为0.47。结论：在同一机构内，由外科医生收治的许多严重创伤患者的死亡率与低容量外科医生的患者没有显著差异，尽管在某些亚组中，不太活跃的外科医生患者的死亡率有上升的趋势。
Background:. Evidence suggests that trauma centers treating high volumes of severely injured patients produce lower mortality rates than those with low volumes. However, the effect of individual surgeons' trauma caseload on outcomes has not been studied. This study compares outcomes between high-volume (HV) trauma surgeons admitting many patients with high injury severity, and low-volume (LV) surgeons treating fewer critical patients per year.Methods. All trauma patients admitted to a large Level I trauma center over a 12-year period were assigned to either the HV or LV group, depending on the yearly volume of their admitting surgeon. Surgeons treating > 35 severely injured (In-jury Severity Score > 15) patients per year were considered HV. Student's t test and X-2 analysis were used to test comparability of LV and HV patient groups and to compare mortality rates. Mortality rates of HV and LV surgeons' patients were compared in six injury patterns selected to represent moderate to severe injury. TRISS methodology (z score) was also used to assess outcomes in the two groups. The inherent bias of the TRISS method in comparing trauma outcomes was minimized by the homogeneity of the studied patient population.Results.' A total of 16,481 patients were admitted to HV surgeons, and 4,214 patients were admitted to LV surgeons. In all subgroups, HV and LV patients were similar regarding age, sex, physiologic status at admission, injury pattern, and injury severity. Mortality rates for HV and LV surgeons were not significantly different between the two groups in any injury pattern. The z score was 1.88 in the HV patient group versus 0.47 in the LV group.Conclusion: Within a single institution, mortality rates for patients treated by surgeons admitting many severely injured patients were not significantly different from low-volume surgeons' patients, although there was a trend toward higher mortality in the less active surgeons' patients in some subgroups.