Association of hospital and surgeon volume of total hip replacement with functional status and satisfaction three years following surgery
Association of hospital and surgeon volume of total hip replacement with functional status and satisfaction three years following surgery
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DOI：
10.1002/art.10754
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发表时间：
2003-02-01
影响因子：
--
通讯作者：
Losina, E
中科院分区：
文献类型：
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作者：
Katz, JN;Phillips, CB;Losina, E
Objective.评估医院容量和外科医生全髋关节置换术（THR）量是否与术后3年患者报告的功能状态和手术满意度相关。我们对1995年在俄亥俄州、宾夕法尼亚州或科罗拉多接受择期初次或翻修THR的医疗保险受益人进行了一项分层随机抽样的人群队列研究。主要结局是自我报告的Harris髋关节评分和经验证的量表，用于测量对手术结果的满意度。术后3年对两种结局进行了评估。医院容量被定义为1995年在医院对医疗保险受益人进行的选择性初次和翻修THR的总数。高流量医院定义为每年进行此类手术> 100例的医院，低流量中心定义为每年进行少于或等于12例手术（初次THR队列）或少于或等于30例手术（翻修队列）的医院。在未调整的分析中，与在高手术量中心进行手术的患者相比，在低手术量中心进行手术的患者在初次和翻修THR后3年的功能状态更差。由低手术量的外科医生进行翻修THR的患者功能也较差。然而，在对社会人口学和临床变量进行调整后，初次THR后较高的住院量与较好的功能状态之间的相关性较弱且无统计学意义，并且未观察到翻修THR后住院或外科医生的住院量与功能状态之间存在统计学意义或临床重要的相关性。与在高手术量中心进行手术的患者相比，在低手术量中心进行选择性初次THR的患者更可能对手术结果不满意。同样，外科医生每年进行少于或等于12例手术的患者比外科医生每年进行> 12例手术的患者更可能对翻修THR的结果不满意。在调整患者社会人口统计学和选择的临床特征后，医院数量和外科医生数量对THR术后3年功能结局的影响很小。然而，在高手术量中心接受手术的患者对初次THR的满意度更高，在高手术量外科医生进行手术的患者对翻修的满意度更高。转诊临床医生应将这些发现纳入考虑THR患者的转诊选择讨论中。关于体积对种植体寿命影响的结论必须等待更长期的随访研究。最后，进一步的研究是必要的，以更好地了解医院和外科医生的程序量和患者对手术的满意度之间的关联。
Objective. To evaluate whether hospital volume and surgeon volume of total hip replacements (THRs) are associated with patient-reported functional status and satisfaction with surgery 3 years postoperatively.Methods. We performed a population-based cohort study of a stratified random sample of Medicare beneficiaries who underwent elective primary or revision THR in Ohio, Pennsylvania, or Colorado in 1995. The primary outcomes were the self-reported Harris hip score and a validated scale measuring satisfaction with the results of surgery. Both outcomes were assessed 3 years postoperatively. Hospital volume was defined as the aggregate number of elective primary and revision THRs performed on Medicare beneficiaries in the hospital in 1995. High-volume hospitals were defined as those in which > 100 such procedures are performed annually, and low-volume centers were defined as those in which less than or equal to 12 procedures (primary THR cohort) or less than or equal to 30 procedures (revision cohort) are performed annually.Results. In unadjusted analyses, patients who underwent surgery in low-volume centers had worse functional status 3 years following primary and revision THR compared with patients whose surgery was performed in higher-volume centers. Patients whose revision THR was performed by a low-volume surgeon also had worse function. After adjustment for sociodem-ographic and clinical variables, however, the association between higher hospital volume and better functional status following primary THR was weak and statistically nonsignificant, and no statistically significant or clinically important associations between hospital or surgeon volume and functional status following revision THR was observed. Patients who underwent elective primary THR in low-volume centers were more likely to be dissatisfied with the results of surgery compared with patients whose surgeries were performed in high-volume centers. Similarly, patients whose surgeons performed less than or equal to 12 procedures per year were more likely to be dissatisfied with the results of revision THR than were patients whose surgeons performed > 12 procedures per year.Conclusion. Hospital volume and surgeon volume have little effect on 3-year functional outcome following THR, after adjusting for patient sociodemographic and select clinical characteristics. However, satisfaction with primary THR is greater among patients who underwent surgery in high-volume centers, and satisfaction with revisions is greater among patients whose operations were performed by higher-volume surgeons. Referring clinicians should incorporate these findings into their discussion of referral choices with patients considering THR. Conclusions regarding the effect of volume on longevity of the implants must await longer-term followup studies. Finally, further research is warranted to better understand the association between hospital and surgeon procedure volume and patient satisfaction with surgery.