Abstract：
Emergency general surgery (EGS) is a high-volume and high-risk surgical service. Interhospital variation in EGS outcomes exists, but there is disagreement in the literature as to whether hospital admission volume affects in-hospital mortality. Scotland collects high-quality data on all admitted patients, whether managed operatively or nonoperatively. Our aim was to determine the relationship between hospital admission volume and in-hospital mortality of EGS patients in Scotland. Second, to investigate whether surgeon admission volume affects mortality.
This national population-level cohort study included EGS patients aged 16 years and older, who were admitted to a Scottish hospital between 2014 and 2018 (inclusive). A logistic regression model was created, with in-hospital mortality as the dependent variable, and admission volume of hospital per year as a continuous covariate of interest, adjusted for age, sex, comorbidity, deprivation, surgeon admission volume, surgeon operative rate, transfer status, diagnosis, and operation category.
There were 376,076 admissions to 25 hospitals, which met our inclusion criteria. The EGS hospital admission rate per year had no effect on in-hospital mortality (odds ratio [OR], 1.000; 95% confidence interval [CI], 1.000-1.000). Higher average surgeon monthly admission volume increased the odds of in-hospital mortality (>35 admissions: OR, 1.139; 95% CI, 1.038-1.250; 25-35 admissions: OR, 1.091; 95% CI, 1.004-1.185; <25 admissions was the referent).
In Scotland, in contrast to other settings, EGS hospital admission volume did not influence in-hospital mortality. The finding of an association between individual surgeons\' case volume and in-hospital mortality warrants further investigation.
Care management, Level IV.
This national population-level cohort study included EGS patients aged 16 years and older, who were admitted to a Scottish hospital between 2014 and 2018 (inclusive). A logistic regression model was created, with in-hospital mortality as the dependent variable, and admission volume of hospital per year as a continuous covariate of interest, adjusted for age, sex, comorbidity, deprivation, surgeon admission volume, surgeon operative rate, transfer status, diagnosis, and operation category.
There were 376,076 admissions to 25 hospitals, which met our inclusion criteria. The EGS hospital admission rate per year had no effect on in-hospital mortality (odds ratio [OR], 1.000; 95% confidence interval [CI], 1.000-1.000). Higher average surgeon monthly admission volume increased the odds of in-hospital mortality (>35 admissions: OR, 1.139; 95% CI, 1.038-1.250; 25-35 admissions: OR, 1.091; 95% CI, 1.004-1.185; <25 admissions was the referent).
In Scotland, in contrast to other settings, EGS hospital admission volume did not influence in-hospital mortality. The finding of an association between individual surgeons\' case volume and in-hospital mortality warrants further investigation.
Care management, Level IV.
摘要：
急诊普外科（EGS）是一项高容量和高风险的手术服务。EGS结果存在医院间差异，但文献中对于入院量是否影响住院死亡率存在分歧.苏格兰收集所有入院患者的高质量数据，无论是手术管理还是非手术管理。我们的目的是确定苏格兰EGS患者的入院量与住院死亡率之间的关系。第二,调查外科医生入院量是否影响死亡率。
这项全国人群水平的队列研究包括16岁及以上的EGS患者，2014年至2018年(含)期间入住苏格兰医院。建立了逻辑回归模型，以住院死亡率为因变量，每年的入院量是一个连续的感兴趣的协变量，根据年龄调整，性别,合并症，剥夺,外科医生入院量，外科医生手术率，传输状态,诊断,和操作类别。
25家医院的接诊人数为376,076人,符合我们的纳入标准。每年EGS住院率对住院死亡率没有影响(比值比[OR]，1.000；95%置信区间[CI]，1.000-1.000)。较高的外科医生平均每月入院量增加了住院死亡率的几率(>35例入院：或，1.139；95%CI，1.038-1.250；25-35入院：或，1.091；95%CI，1.004-1.185；<25个入院是参考）。
在苏格兰,与其他设置相比，EGS入院量不影响住院死亡率。个别外科医生的病例量与住院死亡率之间的关联值得进一步调查。
护理管理，四级。
这项全国人群水平的队列研究包括16岁及以上的EGS患者，2014年至2018年(含)期间入住苏格兰医院。建立了逻辑回归模型，以住院死亡率为因变量，每年的入院量是一个连续的感兴趣的协变量，根据年龄调整，性别,合并症，剥夺,外科医生入院量，外科医生手术率，传输状态,诊断,和操作类别。
25家医院的接诊人数为376,076人,符合我们的纳入标准。每年EGS住院率对住院死亡率没有影响(比值比[OR]，1.000；95%置信区间[CI]，1.000-1.000)。较高的外科医生平均每月入院量增加了住院死亡率的几率(>35例入院：或，1.139；95%CI，1.038-1.250；25-35入院：或，1.091；95%CI，1.004-1.185；<25个入院是参考）。
在苏格兰,与其他设置相比，EGS入院量不影响住院死亡率。个别外科医生的病例量与住院死亡率之间的关联值得进一步调查。
护理管理，四级。
