手术创伤和死亡率:体积的作用
Sarah A Hatfield1, Samuel Medina2, Elizabeth Gorman1
1Department of Surgery, NewYork-Presbyterian/Weill Cornell Medicine, New York, New York.
The Journal of surgical research
|October 19, 2024
概括
在血液控制手术中,手术创伤体积较高与死亡率降低有关. 然而,这种生存益处主要集中在体积非常高的创伤中心,这表明需要进一步研究体积与结果的关系.
科学领域:
- 创伤外科 手术 创伤外科
- 手术结果研究研究.
- 公共卫生 公共卫生
背景情况:
- 手术体积是各种外科领域改善结果的已知预测因素.
- 创伤手术中手术体积和结果之间的关系,特别是用于控制出血,需要进一步阐明.
- 这项研究调查了手术病例数量与创伤护理中的患者死亡率之间的关联.
研究的目的:
- 确定手术创伤量与住院死亡率之间的关联.
- 测试假设,增加的手术容量导致创伤患者在接受血液控制手术时的生存率提高.
主要方法:
- 使用了来自国家创伤数据库 (2017-2020) 的数据.
- 包括在一级或二级创伤中心接受出血控制手术的成年患者 (≥18岁).
- 采用分层后勤回归来分析手术量与死亡率之间的关系,控制患者人口统计和临床因素.
主要成果:
- 对516个创伤中心55469名患者的分析显示,更高的手术量和减少住院死亡率 (OR 0.999) 之间存在显著的关联.
- 然而,一个不包括最繁忙的5%中心的子集分析显示,运营量变得不显著,这表明死亡率的好处是由非常高的数量中心驱动的.
- 观察到每年运营量存在显著的变化,前5%的中心比中间50%的中心执行的案件要多得多.
结论:
- 虽然更高的手术创伤体积与血液控制手术中的死亡率降低有关,但这种益处主要在非常高体积的中心观察到.
- 在这样的高体积中心集中时间敏感的出血控制手术的实用性是具有挑战性的.
- 未来的研究应该探索患者与创伤中心的距离,中心的数量,并确定可修改的因素从高体积的中心更广泛的实施.
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