METHODS: All patients with CD who underwent ICR in France between 2013 and 2022 were identified in the French Database, Programme de Médicalisation des Systèmes d\'Information. Using the Chi-square automatic interaction detector, we determined the cut-off value to split high-surgical-volume [≥6 ICRs/year] and low-surgical-volume centres [<6 ICRs/year]. The primary outcome was the evaluation of major POM during hospitalization. POM was evaluated according to the surgical volume centre. The Elixhauser comorbidity index [ECI] was used to categorize the comorbidities of patients.
RESULTS: A total of 4205 patients were identified, and the major POM during hospitalization was significantly [p = 0.0004] lower in the high-surgical-volume [6.2%] compared to low-surgical-volume centres [9.1%]. After multivariate analysis, independent factors associated with major POM were surgical hospital volume [p = 0.024], male sex [p = 0.029], ECI ≥ 1 [p < 0.001], and minor POM [p < 0.001].
CONCLUSIONS: Major POM after ICR for CD is closely associated with surgical hospital volume. Centralization of surgery for CD is desirable, especially in patients with major comorbidities.
方法:在法国数据库中确定了2013年至2022年在法国接受ICR的所有CD患者,信息系统化方案。使用卡方自动交互检测器,我们确定了高手术量中心(≥6ICR/年)和低手术量中心(<6ICR/年)的分界值.主要结果是住院期间主要POM的评估。根据手术容量中心评估POM。使用Elixhauser合并症指数(ECI)对患者的合并症进行分类。
结果:共确定了4,205名患者,与低手术量中心(9.1%)相比,高手术量中心(6.2%)住院期间的主要POM显著降低(p=0.0004).经过多变量分析,与主要POM相关的独立因素是手术住院量(P=0.024),男性(P=0.029),ECI≥1(P<0.001),和少量POM(P<0.001)。
结论:CD的ICR后的主要POM与外科医院容量密切相关。CD手术的集中化是可取的,尤其是有严重合并症的患者。