Surgical volume impacts bariatric surgery mortality: A case for centers of excellence
Surgical volume impacts bariatric surgery mortality: A case for centers of excellence
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DOI：
10.1016/j.surg.2008.05.013
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发表时间：
2008-11-01
期刊：
影响因子：
3.8
通讯作者：
Cooney, Robert N.
中科院分区：
文献类型：
--
作者：
Hollenbeak, Christopher S.;Rogers, Ann M.;Cooney, Robert N.
背景资料。对护理质量的担忧促使减肥“卓越中心”(COE)的认证过程。据推测，大量的外科医生和医院会有更好的结果。目标。这项以人群为基础的研究考察了宾夕法尼亚州减肥手术量对死亡率的影响。1999至2003年间，从宾夕法尼亚州卫生保健成本控制委员会数据库中确定了在宾夕法尼亚州医院接受胃旁路手术的14,716名患者。个别外科医生和医院被分成高(100例/年)、中等(50-100例/年)或低容量(50例/年)。根据年龄、性别、种族、付款人和医疗组入院情况，检查了外科医生和住院量与住院时间(LOS)、住院时间和30天死亡率的关系。严重程度组(ASC)评分。结果。宾夕法尼亚州共有26-50家低流量医院(n=2,158)、35-54家中等容量医院(n=1,835)和43-高流量医院(n=10,723)。1999年至2003年(30-120例/年)，平均每家医院的容量有所增加。住院死亡率下降(0.8-0.2%)。30天死亡率(1.15%)约为住院死亡率(0.37%)的2倍。男性(优势比[OR]3.6，P
Background. Concerns regarding care quality prompted credentialing processes for bariatric "Centers of Excellence" (COE). It is hypothesized that high-volume surgeons and hospitals have better outcomes. Objective. This population-based study examines the effect of bariatric surgery volume on mortality in Pennsylvania.Methods. Between 1999 and 2003, 14,716 patients having gastric bypass surgery in Pennsylvania hospitals were identified from the Pennsylvania Health Care Cost Containment Council database. Individual surgeons and hospitals were stratified as high (> 100 cases/yr), medium (50-100 cases/yr), or low volume (< 50 cases/yr). The relationship between surgeon and hospital volume on length of stay (LOS), in-hospital, and 30-day mortality were examined, adjusting for age, gender; ethnicity, payor, and MedisGroups Admission. Severity Group (ASC) score.Results. There were 26-50 low (n=2,158), 35-54 medium (n=1,835), and 43-64 high (n=10,723) volume hospitals in Pennsylvania. The mean volume/hospital increased between 1999 and 2003 (30-120 cases/yr) and. in-hospital mortality decreased (0.8-0.2 %). Thirty-day mortality (1.15 %) was approximately 2 times the in-hospital mortality (0.37%). Male gender (odds ratio [OR] 3.6, P