目的:描述了肿瘤外科多个实体的医院容量与结果之间的相关性。迄今为止,尚未对乙状结肠憩室炎的手术治疗进行分析。本研究的目的是探讨每所医院结肠切除术的年病例量对术后并发症发生率的影响。救援失败,憩室炎患者的死亡率。
方法:2012年至2017年接受独立于诊断的结直肠切除术的患者选自德国全国管理数据集。将医院分为五个相等的病例数五分之一(Q1-Q5按病例数递增顺序)。结果分析的重点是接受乙状结肠憩室炎手术的患者。
结果:总计,2012年至2017年记录了662,706例左侧结肠切除术。其中,由于乙状结肠憩室炎进行了156,462次切除,并包括在分析中。整体内部死亡率为3.5%,从第一季度的3.8%(平均每年9.5次手术)到第四季度的3.1%(平均每年62.8次手术;p<0.001)。在多变量逻辑回归分析中,与Q1相比,第5季度医院的住院死亡率风险调整比值比为0.85(95%CI0.78-0.94;p<0.001)。高容量中心显示总体并发症发生率较低,而抢救失败没有显著差异.
结论:高容量结直肠中心乙状结肠憩室炎的手术治疗显示术后死亡率低,术后并发症少。
OBJECTIVE: A correlation between the hospital volume and outcome is described for multiple entities of oncological surgery. To date, this has not been analyzed for the surgical treatment of sigmoid diverticulitis. The aim of this study was to explore the impact of the annual caseload per hospital of colon resection on the postoperative incidence of complications, failure to rescue, and mortality in patients with diverticulitis.
METHODS: Patients receiving colorectal resection independent from the diagnosis from 2012 to 2017 were selected from a German nationwide administrative dataset. The hospitals were grouped into five equal caseload quintiles (Q1-Q5 in ascending caseload order). The outcome analysis was focused on patients receiving surgery for sigmoid diverticulitis.
RESULTS: In total, 662,706 left-sided colon resections were recorded between 2012 and 2017. Of these, 156,462 resections were performed due to sigmoid diverticulitis and were included in the analysis. The overall in-house mortality rate was 3.5%, ranging from 3.8% in Q1 (mean of 9.5 procedures per year) to 3.1% in Q5 (mean 62.8 procedures per year; p < 0.001). Q5 hospitals revealed a risk-adjusted odds ratio of 0.85 (95% CI 0.78-0.94; p < 0.001) for in-hospital mortality compared to Q1 during multivariable logistic regression analysis. High-volume centers showed overall lower complication rates, whereas the failure-to-rescue did not differ significantly.
CONCLUSIONS: Surgical treatment of sigmoid diverticulitis in high-volume colorectal centers shows lower postoperative mortality rates and fewer postoperative complications.