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Abstract：
OBJECTIVE: Hospital case volume is shown to be associated with postoperative outcomes in various types of surgery. However, conflicting results of volume-outcome relationship have been reported in hip fracture surgery. This retrospective cohort study aimed to evaluate the association between hospital case volume and postoperative outcomes in patients who had hip fracture surgery. We hypothesized that higher case volume would be associated with lower risk of in-hospital and one-year mortality after hip fracture surgery.
METHODS: Data for all patients who underwent surgery for hip fracture from January 2008 to December 2016 were extracted from the Korean National Healthcare Insurance Service database. According to mean annual case volume of surgery for hip fracture, hospitals were classified into very low (< 30 cases/year), low (30 to 50 cases/year), intermediate (50 to 100 cases/year), high (100 to 150 cases/year), or very high (> 150 cases/year) groups. The association between hospital case volume and in-hospital mortality or one-year mortality was assessed using the logistic regression model to adjust for age, sex, type of fracture, type of anaesthesia, transfusion, comorbidities, and year of surgery.
RESULTS: Between January 2008 and December 2016, 269,535 patients underwent hip fracture surgery in 1,567 hospitals in Korea. Compared to hospitals with very high volume, in-hospital mortality rates were significantly higher in those with high volume (odds ratio (OR) 1.10, 95% confidence interval ((CI) 1.02 to 1.17, p = 0.011), low volume (OR 1.22, 95% CI 1.14 to 1.32, p < 0.001), and very low volume (OR 1.25, 95% CI 1.16 to 1.34, p < 0.001). Similarly, hospitals with lower case volume showed higher one-year mortality rates compared to hospitals with very high case volume (low volume group, OR 1.15, 95% CI 1.11 to 1.19, p < 0.001; very low volume group, OR 1.10, 95% CI 1.07 to 1.14, p < 0.001).
CONCLUSIONS: Higher hospital case volume of hip fracture surgery was associated with lower in-hospital mortality and one-year mortality in a dose-response fashion. Cite this article: Bone Joint J 2020;102-B(10):1384-1391.
METHODS: Data for all patients who underwent surgery for hip fracture from January 2008 to December 2016 were extracted from the Korean National Healthcare Insurance Service database. According to mean annual case volume of surgery for hip fracture, hospitals were classified into very low (< 30 cases/year), low (30 to 50 cases/year), intermediate (50 to 100 cases/year), high (100 to 150 cases/year), or very high (> 150 cases/year) groups. The association between hospital case volume and in-hospital mortality or one-year mortality was assessed using the logistic regression model to adjust for age, sex, type of fracture, type of anaesthesia, transfusion, comorbidities, and year of surgery.
RESULTS: Between January 2008 and December 2016, 269,535 patients underwent hip fracture surgery in 1,567 hospitals in Korea. Compared to hospitals with very high volume, in-hospital mortality rates were significantly higher in those with high volume (odds ratio (OR) 1.10, 95% confidence interval ((CI) 1.02 to 1.17, p = 0.011), low volume (OR 1.22, 95% CI 1.14 to 1.32, p < 0.001), and very low volume (OR 1.25, 95% CI 1.16 to 1.34, p < 0.001). Similarly, hospitals with lower case volume showed higher one-year mortality rates compared to hospitals with very high case volume (low volume group, OR 1.15, 95% CI 1.11 to 1.19, p < 0.001; very low volume group, OR 1.10, 95% CI 1.07 to 1.14, p < 0.001).
CONCLUSIONS: Higher hospital case volume of hip fracture surgery was associated with lower in-hospital mortality and one-year mortality in a dose-response fashion. Cite this article: Bone Joint J 2020;102-B(10):1384-1391.
摘要：
目的：在各种类型的手术中，医院病例量与术后结局相关。然而,据报道,在髋部骨折手术中,体积-结局关系的结果相互矛盾.这项回顾性队列研究旨在评估髋部骨折手术患者的住院病例量与术后结局之间的关系。我们假设较高的病例量与髋部骨折手术后住院风险和1年死亡率较低相关。
方法：2008年1月至2016年12月接受髋部骨折手术的所有患者的数据来自韩国国家医疗保险服务数据库。根据髋部骨折年平均手术例数，医院被归类为非常低(<30例/年)，低（30至50例/年），中级（50至100例/年），高（100至150例/年），或极高（>150例/年）组。使用logistic回归模型评估住院病例量与住院死亡率或一年死亡率之间的关联，以调整年龄，性别,骨折类型,麻醉类型,输血,合并症,和手术年份。
结果：在2008年1月至2016年12月之间，在韩国的1,567家医院中，269,535名患者接受了髋部骨折手术。与体积很大的医院相比，高容量患者的住院死亡率明显较高（比值比（OR）1.10，95％置信区间（（CI）1.02至1.17，p=0.011），低体积(OR1.22，95%CI1.14至1.32，p<0.001)，体积非常低（OR1.25，95%CI1.16至1.34，p<0.001）。同样，与病例量非常高的医院相比，病例量较低的医院显示出更高的一年死亡率(低量组，OR1.15，95％CI1.11至1.19，p<0.001；非常低体积组，OR1.10，95%CI1.07至1.14，p<0.001)。
结论：以剂量反应方式，髋部骨折手术的住院病例量较高与住院死亡率和1年死亡率较低相关。引用本文：骨关节J2020；102-B（10）：1384-1391。
方法：2008年1月至2016年12月接受髋部骨折手术的所有患者的数据来自韩国国家医疗保险服务数据库。根据髋部骨折年平均手术例数，医院被归类为非常低(<30例/年)，低（30至50例/年），中级（50至100例/年），高（100至150例/年），或极高（>150例/年）组。使用logistic回归模型评估住院病例量与住院死亡率或一年死亡率之间的关联，以调整年龄，性别,骨折类型,麻醉类型,输血,合并症,和手术年份。
结果：在2008年1月至2016年12月之间，在韩国的1,567家医院中，269,535名患者接受了髋部骨折手术。与体积很大的医院相比，高容量患者的住院死亡率明显较高（比值比（OR）1.10，95％置信区间（（CI）1.02至1.17，p=0.011），低体积(OR1.22，95%CI1.14至1.32，p<0.001)，体积非常低（OR1.25，95%CI1.16至1.34，p<0.001）。同样，与病例量非常高的医院相比，病例量较低的医院显示出更高的一年死亡率(低量组，OR1.15，95％CI1.11至1.19，p<0.001；非常低体积组，OR1.10，95%CI1.07至1.14，p<0.001)。
结论：以剂量反应方式，髋部骨折手术的住院病例量较高与住院死亡率和1年死亡率较低相关。引用本文：骨关节J2020；102-B（10）：1384-1391。
