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首页> 外文学位 >Effect of providers' procedural volume complexity on in-hospital complications and length of stay for gastric bypass surgery.
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Effect of providers' procedural volume complexity on in-hospital complications and length of stay for gastric bypass surgery.

机译：提供者的程序量复杂度对胃旁路手术的院内并发症和住院时间的影响。

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摘要

Obesity and morbid obesity represent one of the major public health problems in the United States (U.S.) that affects nearly one-third of the adult American population. Gastric bypass (GB) is a complex operation, performed in a high-risk morbidly obese population, requiring well-trained surgeons and well-equipped hospital facilities to ensure optimal surgical outcomes. The volume-outcomes relationship is well-established for providers (both surgeons and hospitals) performing GB procedures. However, the findings of improved outcomes after GB for high volume providers have been attributed only to the high volume of GB and not the volume of other non-gastric bypass (non-GB) procedures. The studies in this dissertation were undertaken to examine the effect of provider's (general surgeon and hospital) non-GB complex (non-GB C) and non-complex (non-GBNC) volume on in-hospital complications and length of stay (LOS) for patients undergoing GB.;The population-based studies used a combination of various existing retrospective data to address the research objectives. The datasets used include: a two-year (2003-2004) Florida hospital inpatient discharge data as the main analytic dataset, the 2003-2005 work Relative Value Units (RVU) data (available from the Physician Fee Schedule from the Centers of Medicare and Medicaid, to segment the provider's non-GB case load into non-GBC and non-GBNC procedures performed by a provider per year), 2005 Florida hospital characteristics file, 2005 Florida surgeon characteristics file, and 2004 Area Resource File data. Separate generalized estimating equation (GEE) regression models, adjusting standard errors for the non-nested surgeon and hospital cluster effect, were constructed for each outcome: composite complications (one or more complications), technical complications (including unexpected reoperations, splenic injury, hemorrhage, anastomotic leaks, small bowel obstructions, and wound), systemic complications (including pulmonary, cardiac, thromboembolic, genitourinary tract, and postoperative shock), and LOS. Covariates included were patient characteristics, year, surgeon GB volume, and hospital characteristics.;In adjusted analyses, the gastric bypass patients operated by general surgeons with high non-GBNC volume (>142 procedures/year) had 70% and 88% higher likelihood of composite and systemic complications, respectively. In contrast, those operated at hospitals with high non-GBNC volume (>6,478 procedures/year) had 49% and 40% lower likelihood of composite and technical complications, respectively. There was no clear association between providers' high non-GBC volume and adverse outcomes. Furthermore, patients operated by general surgeons with high GB volume (>50 GBs/year) had 27% and 41% lower likelihood of composite and systemic complications, respectively. However, those operated at hospital's with high GB volume (>125 GBs/year) had 30% lower likelihood of technical complications. The study findings suggest that while provider GB volume matters for in-hospital complications, the complexity of overall surgical load also matters for general surgeons but the overall scale matters for hospitals to deliver better in-hospital outcomes for GB. In particular, the outcomes may improve if GB patients avoided general surgeons with a high volume of non-complex procedures and if GB patients avoided hospitals with low total volume.
机译：肥胖症和病态肥胖症是美国（美国）的主要公共卫生问题之一，其影响了近三分之一的美国成年人口。胃旁路手术（GB）是一项复杂的手术，在高风险的病态肥胖人群中进行，需要训练有素的外科医生和设备齐全的医院设施才能确保最佳手术效果。对于执行GB程序的提供者（外科医生和医院），数量-结果关系是公认的。但是，对于大剂量提供者，GB术后结局改善的结果仅归因于GB的大量，而不是其他非胃旁路（non-GB）程序的量。本论文的研究旨在检验提供者（普通外科医生和医院）非GB复合体（非GB C）和非复合体（非GBNC）的体积对医院内并发症和住院时间（LOS）的影响）；针对接受GB治疗的患者。基于人群的研究结合了各种现有的回顾性数据来解决研究目标。所使用的数据集包括：佛罗里达州医院的住院病人两年（2003-2004年）数据作为主要分析数据集，2003-2005年工作相对价值单位（RVU）数据（可从Medicare和Medicaid，将提供者的非GB病例负荷划分为提供者每年执行的非GBC和非GBNC程序），2005佛罗里达医院特征文件，2005佛罗里达外科医生特征文件和2004区域资源文件数据。针对每种结局构建了单独的广义估计方程（GEE）回归模型，针对非嵌套外科医生和医院群效应调整标准误差：复合并发症（一种或多种并发症），技术并发症（包括意外再手术，脾损伤，出血） ，吻合口漏，小肠梗阻和伤口），全身并发症（包括肺，心脏，血栓栓塞，泌尿生殖道和术后休克）和LOS。协变量包括患者特征，年份，外科医生GB量和医院特征。；在调整后的分析中，由非GBNC高容量（> 142程序/年）的普通外科医生手术的胃旁路手术患者的可能性分别高70％和88％分别为复合性和全身性并发症。相比之下，在非GBNC量较高（> 6,478程序/年）的医院中进行手术的患者，复合和技术并发症的发生率分别降低49％和40％。提供者的非GBC量高和不良后果之间没有明确的关联。此外，由具有高GB容量（> 50 GB /年）的普通外科医师手术的患者发生复合和全身并发症的可能性分别降低27％和41％。但是，那些在医院中使用大量GB容量（> 125 GB /年）的患者发生技术并发症的可能性降低了30％。研究结果表明，尽管提供者的GB量对院内并发症很重要，但总手术量的复杂性对普通外科医师也很重要，但是总体规模对医院来说要对GB的院内结局更好。特别是，如果GB患者避免了使用大量非复杂手术的普通外科医师，并且GB患者避免了使用总量较小的医院，则结果可能会改善。

著录项

  • 作者

    Kamble, Shital P.;

  • 作者单位

    The University of North Carolina at Charlotte.;

  • 授予单位 The University of North Carolina at Charlotte.;
  • 学科 Health Sciences Medicine and Surgery.;Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2009
  • 页码 213 p.
  • 总页数 213
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类
  • 关键词

  • 入库时间 2022-08-17 11:38:19

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