Abstract：
To investigate the impact of facility volume on Patient Safety Indicator (PSI) events following transsphenoidal pituitary surgery (TSPS).
Retrospective database review.
National Inpatient Sample database (2003-2011).
The National Inpatient Sample was queried for TSPS cases from 2003 to 2011. Facility volume was defined by tertile of average annual number of TSPS procedures performed. PSIs, based on in-hospital complications identified by the Agency of Healthcare Research and Quality, and poor outcomes, such as mortality and tracheostomy, were analyzed.
An overall 16,039 cases were included: 804 had ≥1 PSI and 15,235 had none. A greater proportion of male to female (5.8% vs 4.3%) and Black to White (7.0% vs 4.5%) patients experienced PSIs. There was an increased likelihood of poor outcome (odds ratio [OR], 3.1 [95% CI, 2.5-3.7]; P < .001) and mortality (OR, 30.1 [95% CI, 18.5-48.8]; P < .001) with a PSI. The incidence rates of PSIs at low-, intermediate-, and high-volume facilities were 5.7%, 5.1%, and 4.2%, respectively. Odds of poor outcome with PSIs were greater at low-volume facilities (OR, 3.3 [95% CI, 2.4-4.4]; P < .001) vs intermediate (OR, 3.1 [95% CI, 2.1-4.2]; P < .001) and high (OR, 2.5 [95% CI, 1.7-3.8]; P < .001). Odds of mortality with PSIs were greater at high-volume facilities (OR, 43.0 [95% CI, 14.3-129.4]; P < .001) vs intermediate (OR, 40.0 [95% CI, 18.5-86.4]; P < .001) and low (OR, 17.3 [95% CI, 8.0-37.7]; P < .001).
PSIs were associated with a higher likelihood of poor outcome and mortality following TSPS. Patients who experienced PSIs had a lower risk of poor outcome but increased mortality at higher-volume facilities.
Retrospective database review.
National Inpatient Sample database (2003-2011).
The National Inpatient Sample was queried for TSPS cases from 2003 to 2011. Facility volume was defined by tertile of average annual number of TSPS procedures performed. PSIs, based on in-hospital complications identified by the Agency of Healthcare Research and Quality, and poor outcomes, such as mortality and tracheostomy, were analyzed.
An overall 16,039 cases were included: 804 had ≥1 PSI and 15,235 had none. A greater proportion of male to female (5.8% vs 4.3%) and Black to White (7.0% vs 4.5%) patients experienced PSIs. There was an increased likelihood of poor outcome (odds ratio [OR], 3.1 [95% CI, 2.5-3.7]; P < .001) and mortality (OR, 30.1 [95% CI, 18.5-48.8]; P < .001) with a PSI. The incidence rates of PSIs at low-, intermediate-, and high-volume facilities were 5.7%, 5.1%, and 4.2%, respectively. Odds of poor outcome with PSIs were greater at low-volume facilities (OR, 3.3 [95% CI, 2.4-4.4]; P < .001) vs intermediate (OR, 3.1 [95% CI, 2.1-4.2]; P < .001) and high (OR, 2.5 [95% CI, 1.7-3.8]; P < .001). Odds of mortality with PSIs were greater at high-volume facilities (OR, 43.0 [95% CI, 14.3-129.4]; P < .001) vs intermediate (OR, 40.0 [95% CI, 18.5-86.4]; P < .001) and low (OR, 17.3 [95% CI, 8.0-37.7]; P < .001).
PSIs were associated with a higher likelihood of poor outcome and mortality following TSPS. Patients who experienced PSIs had a lower risk of poor outcome but increased mortality at higher-volume facilities.
摘要：
目的：研究设施容量对经蝶入路垂体手术（TSPS）后患者安全指标（PSI）事件的影响。
方法：回顾性数据库回顾。
方法：国家住院患者样本数据库（2003-2011）。
方法：对2003年至2011年的全国住院患者样本进行了TSPS病例查询。设施容量由每年执行的TSPS程序的平均数量的三分位数定义。PSIs,根据医疗保健研究和质量机构确定的院内并发症，和糟糕的结果，如死亡率和气管造口术，进行了分析。
结果：共纳入16,039例：804例≥1PSI，15,235例≥1PSI。男性对女性（5.8％vs4.3％）和黑人对白人（7.0％vs4.5％）患者的比例更高。结果不佳的可能性增加(赔率比[OR]，3.1[95%CI，2.5-3.7]；P<.001）和死亡率（OR，30.1[95%CI，18.5-48.8]；P<.001)，PSI。PSIs的发病率低，中介-，高容量设施占5.7%，5.1%,和4.2%，分别。在低容量设施中，PSIs不良结果的可能性更大(或，3.3[95%CI，2.4-4.4]；P<.001)与中间（OR，3.1[95%CI，2.1-4.2]；P<.001)和高(OR，2.5[95%CI，1.7-3.8]；P<.001）。在高容量设施中，PSIs的死亡几率更大(或，43.0[95%CI，14.3-129.4]；P<.001)与中间（OR，40.0[95%CI，18.5-86.4]；P<.001)和低(OR，17.3[95%CI，8.0-37.7]；P<.001）。
结论：PSIs与TSPS后不良结局和死亡率的可能性更高相关。经历过PSIs的患者预后不良的风险较低，但在高容量设施中死亡率增加。
方法：回顾性数据库回顾。
方法：国家住院患者样本数据库（2003-2011）。
方法：对2003年至2011年的全国住院患者样本进行了TSPS病例查询。设施容量由每年执行的TSPS程序的平均数量的三分位数定义。PSIs,根据医疗保健研究和质量机构确定的院内并发症，和糟糕的结果，如死亡率和气管造口术，进行了分析。
结果：共纳入16,039例：804例≥1PSI，15,235例≥1PSI。男性对女性（5.8％vs4.3％）和黑人对白人（7.0％vs4.5％）患者的比例更高。结果不佳的可能性增加(赔率比[OR]，3.1[95%CI，2.5-3.7]；P<.001）和死亡率（OR，30.1[95%CI，18.5-48.8]；P<.001)，PSI。PSIs的发病率低，中介-，高容量设施占5.7%，5.1%,和4.2%，分别。在低容量设施中，PSIs不良结果的可能性更大(或，3.3[95%CI，2.4-4.4]；P<.001)与中间（OR，3.1[95%CI，2.1-4.2]；P<.001)和高(OR，2.5[95%CI，1.7-3.8]；P<.001）。在高容量设施中，PSIs的死亡几率更大(或，43.0[95%CI，14.3-129.4]；P<.001)与中间（OR，40.0[95%CI，18.5-86.4]；P<.001)和低(OR，17.3[95%CI，8.0-37.7]；P<.001）。
结论：PSIs与TSPS后不良结局和死亡率的可能性更高相关。经历过PSIs的患者预后不良的风险较低，但在高容量设施中死亡率增加。
