The More the Better? The Impact of Surgeon and Hospital Volume on in-Hospital Mortality Following Colorectal Resection
The More the Better? The Impact of Surgeon and Hospital Volume on in-Hospital Mortality Following Colorectal Resection
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DOI：
10.1097/sla.0b013e3181a77bcd
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发表时间：
2009-06-01
影响因子：
9
通讯作者：
Guyatt, Gordon H.
中科院分区：
文献类型：
--
作者：
Karanicolas, Paul J.;Dubois, Luc;Guyatt, Gordon H.
目的：确定因恶性或良性疾病接受结直肠切除术的患者的院内死亡率，并确定院内死亡的危险因素，特别是与外科医生和医院容量的关系。背景：尽管有强有力的证据表明，复杂的癌症手术最好在专业的高容量中心和高容量外科医生进行，外科医生和医院容量与围手术期结果之间的关系对于更常见的程序（例如结肠直肠切除术，特别是对于良性疾病）不太明确。我们从加拿大健康信息研究所出院摘要数据库中获得了所有在4月1日之间接受结直肠切除术的成年患者的数据。2005年和2006年3月31日。我们进行了logistic回归，以确定与较高的可能性在医院death.Results：21074例患者进行了结直肠切除术，大多数是择期（59.4%）的变量。憩室是最常见的切除适应症（56.8%），其次是憩室病（16.2%）和炎症性肠病（7.1%）。接受结直肠切除术的患者的总体住院死亡率为5.3%。年龄增加（校正比值比[OR]：1.97/10岁，P < 0.001）、紧急手术（OR：2.63，P < 0.001）、切除指征（P < 0.001）、手术性质（P < 0.001）和几种合并症均与死亡风险增加独立相关。结直肠切除量较大的外科医生的死亡率显著较低（OR：0.92/20例/年，P = 0.003），相当于最低十分位外科医生（每年1例）的校正死亡率为5.6%，而最高十分位外科医生（每年超过43例）的校正死亡率为4.5%。医院容量与死亡率无关（OR：1.00每10例，P = 0.504）。结论：这项大型的，以人群为基础的研究表明，外科医生谁执行高容量的结直肠切除术实现较低的住院死亡率比外科医生与低容量，而医院容量并不影响死亡率。
Objective: To determine the in-hospital mortality rates for patients undergoing colorectal resection for malignant or benign conditions, and to identify risk factors for in-hospital death, particularly the relationships with surgeon and hospital volume.Background: Although there is strong evidence that complex cancer operations are best performed at specialized high-volume centers and by high-volume surgeons, the relationship between surgeon and hospital volume and perioperative outcomes is, less well defined for more common procedures such as colorectal resections, particularly for benign diseases.Methods: We obtained data from the Canadian Institute for Health-information Discharge Abstract Database on all adult patients who underwent colorectal resection between April 1. 2005 and March 31, 2006. We performed a logistic regression to identify variables associated with a higher likelihood of in-hospital death.Results: Twenty-one thousand seventy-four patients underwent colorectal resection, with the majority being elective (59.4%). Malignancy represented the most common indication for resection (56.8%), followed by diverticular disease (16.2%) and inflammatory bowel disease (7.1%). The overall in-hospital mortality rate among patients undergoing colorectal resection was 5.3%. Increased age (adjusted Odds Ratio [OR]: 1.97 per 10 years, P < 0.001), urgent operation (OR: 2.63, P < 0.001), indication for resection (P < 0.001), nature of the surgery (P < 0.001), and several comorbidities were all independently associated with an increased risk of death. Surgeons with higher volumes of colorectal resections achieved significantly lower mortality rates (OR: 0.92 per 20 cases/y, P = 0.003), corresponding to an adjusted mortality rate of 5.6% for surgeons in the bottom decile (1 case per year) compared with 4.5% for surgeons in the top decile (greater than 43 cases per year). Hospital volume was not associated with mortality (OR: 1.00 per 10 cases, P = 0.504).Conclusions: This large, population-based study suggests that surgeons who perform high volumes of colorectal resections achieve lower in-hospital mortality rates than surgeons with low volumes, whereas the hospital volume does not influence mortality.