Impact of surgeon volume on the morbidity and costs of radical cystectomy in the USA: a contemporary population-based analysis
Impact of surgeon volume on the morbidity and costs of radical cystectomy in the USA: a contemporary population-based analysis
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DOI：
10.1111/bju.12749
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发表时间：
2015-05-01
影响因子：
4.5
通讯作者：
Chang, Steven L.
中科院分区：
文献类型：
--
作者：
Leow, Jeffrey J.;Reese, Stephen;Chang, Steven L.
目的探讨美国膀胱癌根治术手术量与术后发病率的关系，并评估膀胱癌的经济负担。方法采用全国医院出院数据库，收集2003年至2010年间接受RC（国际疾病分类，第九版，代码57.71）治疗的所有患者。评估患者、医院和手术特点。外科医生每年进行的RCs量被分成五分位数。建立多变量回归模型，调整聚类和调查权重，以评估结果，包括90天主要并发症（Clavien III-V级）和直接患者成本。我们对聚类和加权进行了调整，以实现具有全国代表性的分析。结果加权队列包括49792例接受RC的患者，总90天主要并发症发生率为16.2%。与每年进行1次RCs手术相比，每年进行>= 7次RCs手术的主要并发症发生率降低45%（优势比[OR] 0.55; P < 0.001），成本降低1690美元（P = 0.02）。当我们将外科手术容积作为一个连续变量进行分析时，当我们检查容积最大的外科医生（每年= 28例）时，结果是一致的，与容积最小的外科医生相比，其主要并发症的发生率显着降低（OR 0.45, 95% CI 0.31-0.67; P < 0.001）。与没有任何并发症的患者相比，有主要并发症的患者90天直接住院费用中位数明显较高（43 965美元vs 24 341美元；P < 0.001）。结论手术量与术后90天主要并发症发生率及直接住院费用呈反比关系。将RC集中到容量较大的外科医生可以减少术后主要并发症的发生，从而减轻膀胱癌对医疗保健系统的负担。
ObjectivesTo evaluate the relationship between surgeon volume of radical cystectomy (RC) and postoperative morbidity, and to assess the economic burden of bladder cancer in the USA.MethodsWe captured all patients who underwent RC (International Classification of Diseases, ninth revision, code 57.71) between 2003 and 2010, using a nationwide hospital discharge database. Patient, hospital and surgical characteristics were evaluated. The annual volume of RCs performed by the surgeons was divided into quintiles. Multivariable regression models were developed, adjusting for clustering and survey weighting, to evaluate the outcomes, including 90-day major complications (Clavien grade III-V) and direct patient costs. We adjusted for clustering and weighting to achieve a nationally representative analysis.ResultsThe weighted cohort included 49 792 patients who underwent RC, with an overall 90-day major complication rate of 16.2%. Compared with surgeons performing one RC annually, surgeons performing >= 7 RCs each year had 45% lower odds of major complications (odds ratio [OR] 0.55; P < 0.001) and lower costs by $ 1690 (P = 0.02). Results were consistent when we analysed surgeon volume as a continuous variable and when we examined the surgeons with the highest volumes (= 28 cases annually), which showed markedly lower odds of major complications compared with the surgeons with the lowest volumes (OR 0.45, 95% CI 0.31-0.67; P < 0.001). Compared with patients who did not have any complications, those who had a major complication were associated with significantly higher 90-day median direct hospital costs ($43 965 vs $24 341; P < 0.001).ConclusionsWe showed that there was an inverse relationship between surgeon volume and the development of postoperative 90-day major complication rates as well as direct hospital costs. Centralisation of RC to surgeons with higher volumes may reduce the development of postoperative major complications, thereby decreasing the burden of bladder cancer on the healthcare system.