Variations among high volume surgeons in the rate of complications after radical prostatectomy: Further evidence that technique matters
Variations among high volume surgeons in the rate of complications after radical prostatectomy: Further evidence that technique matters
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DOI：
10.1097/01.ju.0000158163.21079.66
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发表时间：
2005-06-01
影响因子：
6.6
通讯作者：
Scardino, PT
中科院分区：
文献类型：
--
作者：
Bianco, FJ;Riedel, ER;Scardino, PT
目的：外科医生、医院容量和根治性直肠癌切除术的术后发病率之间有很强的相关性。虽然更好的结果与高vohume外科医生，外科医生之间的结果的变化程度还没有得到充分的examined.Materials和方法：使用一个链接的数据库，从监测，流行病学和最终结果，3注册和联邦医疗保险索赔数据，我们分析了连续患者的结果与根治性直肠癌切除术治疗1992年和1996年之间。我们重点关注了高手术量外科医生（定义为研究期间有20名或更多患者）患者的几项发病率指标（围手术期并发症、晚期泌尿系统并发症和长期尿失禁）的变化。在调整医院，外科医生数量和病例组合后，我们检查了所有3个终点的外科医生之间不良结局发生率差异的程度：在999名外科医生中，16%（159名）在研究期间进行了10，737例根治性前列腺切除术中的48.7%（5，238名）。30天死亡率为0.5%，术后主要并发症发生率为28.6%，晚期泌尿系统并发症发生率为25.2%（主要事件16%），长期尿失禁发生率为6.7%。对于所有3种发病率结局，在调整协变量后，外科医生之间并发症发生率的差异显著大于随机预期（每种p = 0.001）。此外，外科医生与更好（或更差）比平均结果方面的1个结果很可能有更好（或更差，分别）的结果方面的其他2 outcome measurements.Conclusions：直接影响生活质量的死亡率终点表现出显着的变异性之间的高容量供应商。在1个方面表现良好的外科医生（例如术后并发症）在其他方面表现良好。这些结果进一步表明，手术技术和术后护理的变化会导致根治性直肠癌切除术后结局的变化，表明该手术的结局对性能的微小差异敏感。
Purpose: A strong association between surgeon, hospital volume and postoperative morbidity of radical prostatectomy has been demonstrated. While better outcomes are associated with high vohume surgeons, the degree of variation in outcomes among surgeons has not been fully examined.Materials and Methods: Using a linked database from Surveillance, Epidemiology and End Result,3 registries and federal Medicare claims data, we analyzed outcomes of consecutive patients treated with radical prostatectomy between 1992 and 1996. We focused on variations in several measures of morbidity (perioperative complications, late urinary complications and long-term incontinence) among patients of high volume surgeons, defined as those with 20 or more patients in the study period. After adjusting for hospital, surgeon volume and case mix, we examined the extent to which variations in the rates of adverse outcomes differed among surgeons for all 3 end points.Results: Of the 999 surgeons 16% (159) performed 48.7% (5,238) of the 10,737 radical prostatectomies during the study. The 30-day mortality rate was 0.5%, the major postoperative complication rate was 28.6%, late urinary complications 25.2% (major events 16%) and long-term incontinence 6.7%. For all 3 morbidity outcomes the variation among surgeons in the rate of complications was significantly greater than that expected by chance (p = 0.001 for each) after adjustment of covariates. Furthermore, surgeons with better (or worse) than average results with regard to 1 outcome were likely to have better (or worse, respectively) results with regard to the other 2 outcome measures.Conclusions: Morbidity end points that directly affect quality of life showed significant variability among high volume providers. Surgeons who performed well in 1 area (eg postoperative complications) performed well in others. These results further suggest that variations in surgical technique and postoperative care lead to variations in outcomes after radical prostatectomy, indicating that outcomes of this operation are sensitive to small differences in performance.