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首页> 外文期刊>Neurosurgery >Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes.
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Microvascular decompression surgery in the United States, 1996 to 2000: mortality rates, morbidity rates, and the effects of hospital and surgeon volumes.

机译：美国1996至2000年的微血管减压手术：死亡率，发病率以及医院和外科医生的影响。

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OBJECTIVE: Microvascular decompression (MVD) is associated with low mortality and morbidity rates at specialized centers, but many MVD procedures are performed outside such centers. We studied short-term end points after MVD in a national hospital discharge database sample. METHODS: A retrospective cohort study was performed by using the Nationwide Inpatient Sample, 1996 to 2000. RESULTS: The sample included 1326 MVD procedures for treatment of trigeminal neuralgia, 237 for treatment of hemifacial spasm, and 27 for treatment of glossopharyngeal neuralgia, performed at 305 hospitals by 277 identified surgeons. The mortality rate was 0.3%, and the rate of discharge other than to home was 3.8%. Neurological complications were coded in 1.7% of cases, hematomas in 0.5%, and facial palsies in 0.6%, with 0.4% of patients requiring ventriculostomies and 0.7% postoperative ventilation. Trigeminal nerve section was also coded for 3.4% of patients with trigeminal neuralgia, more commonly among older patients (P =0.08), among female patients (P = 0.03), and at teaching hospitals (P = 0.02). The median annual caseloads were 5 cases per hospital (range, 1-195 cases) and 3 cases per surgeon (range, 1-107 cases). With adjustment for age, sex, race, primary insurance, diagnosis (trigeminal neuralgia versus hemifacial spasm versus glossopharyngeal neuralgia), geographic region, admission type and source, and medical comorbidities, outcomes at discharge were superior at higher-volume hospitals (P = 0.006) and with higher-volume surgeons (P = 0.02). Complications were less frequent after surgery performed at high-volume hospitals (P = 0.04) or by high-volume surgeons (P = 0.01). The rate of discharge other than to home was 5.1% for the lowest-volume-quartile hospitals, compared with 1.6% for the highest-volume-quartile hospitals. Volume and mortality rate were not significantly related, but three of the four deaths in the series followed procedures performed by surgeons who had performed only one MVD procedure that year. Length of stay (median, 3 d) and hospital volume were not significantly related. Hospital charges were slightly higher at higher-volume hospitals (P = 0.007). CONCLUSION: Although most MVD procedures in the United States are performed at low-volume centers, mortality rates remain low. Morbidity rates are significantly lower at high-volume hospitals and with high-volume surgeons.
机译：目的：微血管减压术（MVD）与专门中心的死亡率和发病率低有关，但是许多MVD手术是在此类中心之外进行的。我们在国家医院出院数据库样本中研究了MVD之后的短期终点。方法：采用1996年至2000年全国住院患者样本进行回顾性队列研究。结果：该样本包括1326例三叉神经痛的MVD程序，237例面肌痉挛的治疗和27例舌咽神经痛的治疗。 277位外科医生中的305家医院。死亡率为0.3％，除家外出院率为3.8％。神经并发症的发生率为1.7％，血肿为0.5％，面神经麻痹为0.6％，其中0.4％的患者需要进行脑室切开术，而0.7％的患者需要术后通气。在三叉神经痛患者中，三叉神经节占3.4％，在老年患者（P = 0.08），女性患者（P = 0.03）和教学医院（P = 0.02）中更为常见。每家医院的年平均病例数为5例（范围为1-195例），每名外科医生为3例（范围为1-107例）。通过调整年龄，性别，种族，基本保险，诊断（三叉神经痛，面肌痉挛与舌咽神经痛），地理区域，入院类型和来源以及医疗合并症，大医院的出院结局更好（P = 0.006 ）和大批量的外科医生（P = 0.02）。在大医院（P = 0.04）或大外科医师（P = 0.01）进行手术后，并发症的发生率较低。数量最少的四分之一医院的出院率为5.1％，而数量最多的四分之一医院为1.6％。体积和死亡率没有显着相关性，但是该系列四例死亡中的三例遵循当年仅进行过一次MVD手术的外科医生进行的手术。住院时间（中位数，3 d）和医院容量没有显着相关。大型医院的住院费用略高（P = 0.007）。结论：尽管在美国大多数MVD程序是在低容量中心执行的，但死亡率仍然很低。在大医院和大手术医生中，发病率显着降低。

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