摘要
目的 探讨存在于外科医生大型手术量与手术结果之间的某种关联是否同样存在于小型手术。设计 汇总分析在瑞典进行的疝修补术的术后结果。地点 瑞典疝登记处备案注册的外科单位，2004年大约完成全瑞典疝修补术总例数的95％。参与者自1996年至2004年，在参研外科单位中共有86409例15岁以上患者入选，实施单侧或双侧腹股沟疝修补术96601例（94077例腹股沟疝加2524例股疝）。主要结局评估指标复发后再次手术。结果 与每年疝修补术例数较多的外科医生相比，每年只完成1～5例疝修补术的外科医生进行再次手术的比率显著增高。手术结果与进一步提高外科医生手术量之间无关联。尽管在瑞典大约有半数外科医生完成的疝修补术例数都很低，但只占所有疝修补术总例数的8．4％。结论在瑞典，有许多疝外科医生的手术量都很低，但只占总手术例数中的很小一部分，所以尽管其手术结果不佳，但对全国再次手术率的影响极其微小。外科医生手术量只是大概提示了一名外科医生每年应该完成的疝修补术例数的最小数值，但是对于手术量超过该数值的外科医生，手术量并不能提示其手术熟练程度。
Objective To determine whether the association between volume and outcome found in major surgery also holds true for a minor operation. Design Review of outcomes after hernia surgery in Sweden. Setting Surgical units registered with the Swedish hernia register, which in 2004 covered about 95% of all hernia operations in Sweden. Participants 86 409 patients over 15 years, who underwent 96 601 unilateral or bilateral groin hernia repairs （94 077 inguinal and 2524 femoral） in 1996 - 2004 at the participating surgical units. Main outcome measures Re-operation for recurrence. Results There was a significantly higher rate of re-operation in surgeons who carried out 1 -5 repairs a year than in surgeons who carried out more repairs. There was no association between outcome and further increases in volume. Although about half of surgeons in Sweden who repair hernias are low volume operators, they performed only 8.4% of all repairs. Conclusions Sweden＇s numerous low volume hernia surgeons perform such a small proportion of all operations that the impact of their inferior results on the nationwide re-operation rate is minimal. Volume indicates an approximate minimum value for the number of hernia repairs a surgeon should do each year but the outcome in surgeons who carry out more than that number disqualifies volume as an indicator of proficiency.
出处
《英国医学杂志中文版》
2008年第4期215-218,共4页
The BMJ Chinese Edition
基金
感谢David Carter、Johannes Jarhult、Erik Nilsson及Lennart Gustafsson所提供的专业意见,并感谢登记处秘书Annika Enarsson以及相关附属医院外科医生所提供的帮助和支持.瑞典疝登记处由全瑞医疗保健和福利委员会、瑞典地方权利机构协会以及加姆特兰郡议会提供经济资助.在瑞典疝登记处备案注册的外科医疗单位在www.svensktbrackregister,se/kliniker.html有详细说明.
