Effect of Hospital Volume on Outcomes of Laparoscopic Appendectomy for Acute Appendicitis: an Observational Study
Effect of Hospital Volume on Outcomes of Laparoscopic Appendectomy for Acute Appendicitis: an Observational Study
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DOI：
10.1007/s11605-015-2746-y
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发表时间：
2015-05-01
影响因子：
3.2
通讯作者：
Matsuda, Shinya
中科院分区：
文献类型：
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作者：
Murata, Atsuhiko;Mayumi, Toshihiko;Matsuda, Shinya
本研究调查了2010年至2012年在日本825家医院接受腹腔镜阑尾切除术治疗急性阑尾炎的30，525例患者的医院容量对腹腔镜阑尾切除术结果的影响。我们比较了阑尾切除术相关并发症、住院时间（LOS）和与医院容量相关的医疗费用。在本研究期间，医院分为低流量医院（LVH，< 50例）、中等流量医院（MVH，50-100例）或高流量医院（HVH，> 100例）。在LVH、MVH和HVH之间观察到阑尾切除术相关并发症的显著差异（分别为6.9%、7.2%和6.0%; p = 0.001）。多因素Logistic回归分析显示，HVH与阑尾切除术相关并发症的相对风险低于LVH和MVH（比值比[OR]，0.84; 95%置信区间[CI]，0.74-0.95; p = 0.006）。多元线性回归显示，HVH与较短的LOS和较低的医疗费用比LVH和MVH。LOS的非标准化系数为-0.92天（95%CI，-1.07至-0.78; p < 0.001），而医疗费用的非标准化系数为-aEuro parts per thousand $167.4（95%CI，-256.2至-78.6; p < 0.001）。
This study investigated the effect of hospital volume on outcomes of laparoscopic appendectomy for acute appendicitis.In total, 30,525 patients who underwent laparoscopic appendectomy for acute appendicitis were referred to 825 hospitals in Japan from 2010 to 2012. We compared appendectomy-related complications, length of stay (LOS), and medical costs in relation to hospital volume. For this study period, hospitals were categorized as low-volume hospitals (LVHs, < 50 cases), medium-volume hospitals (MVHs, 50-100 cases), or high-volume hospitals (HVHs, > 100 cases).Significant differences in appendectomy-related complications were observed among the LVHs, MVHs, and HVHs (6.9, 7.2, and 6.0 %, respectively; p = 0.001). Multiple logistic regression revealed that HVHs were associated with a lower relative risk of appendectomy-related complications than were LVHs and MVHs (odds ratio [OR], 0.84; 95 % confidence interval [CI], 0.74-0.95; p = 0.006). Multiple linear regression showed that HVHs were associated with shorter LOS and lower medical costs than were LVHs and MVHs. The unstandardized coefficient for LOS was -0.92 days (95 % CI, -1.07 to -0.78; p < 0.001), whereas that for medical costs was -aEuro parts per thousand$167.4 (95 % CI, -256.2 to -78.6; p < 0.001).Hospital volume was significantly associated with laparoscopic appendectomy outcomes.