Impact of Operative Volume on Outcomes of Component Separation in Abdominal Wall Reconstruction.

IF 0.9 4区 医学 Q3 SURGERY
Arjun Chaturvedi, Oh Jin Kwon, Nam Yong Cho, Nguyen Le, Dariush Yalzadeh, Daniel Tabibian, Barzin Badiee, Ashkan Moazzez, Peyman Benharash
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引用次数: 0

Abstract

BackgroundComponent separation technique (CST) has emerged as a novel surgical strategy in the management of large and complex hernia defects. Although prior work has associated CST with decreased hernia recurrence and improved clinical outcomes, the impact of hospital-level variation in component separation utilization remains understudied.MethodsThis retrospective cohort study investigated the impact of operative volume on outcomes in patients undergoing CST. All adult (≥18 years) records for elective CST procedures were tabulated using the 2016-2021 Nationwide Readmissions Database. Hospitals ranked in the top quartile of annual CST volume were defined as high-volume hospitals (HVH; others LVH, MVH, and MHVH). Multivariable regression models were developed to characterize the association between HVH status and outcomes of interest.ResultsOf an estimated 12 720 patients undergoing component separation, 3359 (26.3%) underwent treatment at HVH. Although CST utilization increased significantly over the study period, the total number of high-volume centers remained relatively stable. Additionally, Medicaid recipient status, lowest income quartile, and treatment at rural hospitals were all associated with lower odds of component separation use. Following comprehensive risk adjustment, HVH status was associated with decreased odds of major adverse events (AOR [adjusted odds ratio] 0.75, 95% CI [0.61, 0.91], P = 0.003). However, the HVH cohort had similar resource utilization compared to their LVH, MVH, and MHVH counterparts.DiscussionHigher CST hospital volume was linked with improved clinical outcomes without increased resource utilization. Persistent disparities in component separation utilization highlight the need for protocol standardization and expanded access to specialized surgical care nationally.

腹壁重建术中手术体积对构件分离效果的影响。
背景成分分离技术(CST)已成为一种新的手术策略,用于治疗大而复杂的疝缺损。尽管先前的研究已将CST与减少疝复发和改善临床结果联系起来,但医院水平差异对组分分离利用的影响仍未得到充分研究。方法本回顾性队列研究探讨手术体积对CST患者预后的影响。所有选择性CST手术的成人(≥18岁)记录使用2016-2021年全国再入院数据库制成表格。年度CST业务量排名前四分之一的医院被定义为高业务量医院(HVH;其他为LVH、MVH和MHVH)。建立了多变量回归模型来描述HVH状态与相关结果之间的关系。结果在12720例接受成分分离的患者中,3359例(26.3%)在HVH接受了治疗。尽管在研究期间,CST的利用率显著增加,但高容量中心的总数保持相对稳定。此外,医疗补助接受者状态、最低收入四分位数和在农村医院的治疗都与较低的成分分离使用几率相关。综合风险调整后,HVH状态与主要不良事件发生率降低相关(AOR[校正优势比]0.75,95% CI [0.61, 0.91], P = 0.003)。然而,与LVH、MVH和MHVH组相比,HVH组的资源利用率相似。在不增加资源利用率的情况下,较高的CST医院容量与改善的临床结果相关。组分分离利用的持续差异突出了协议标准化和扩大全国专科外科护理的必要性。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
American Surgeon
American Surgeon 医学-外科
CiteScore
1.40
自引率
0.00%
发文量
623
期刊介绍: The American Surgeon is a monthly peer-reviewed publication published by the Southeastern Surgical Congress. Its area of concentration is clinical general surgery, as defined by the content areas of the American Board of Surgery: alimentary tract (including bariatric surgery), abdomen and its contents, breast, skin and soft tissue, endocrine system, solid organ transplantation, pediatric surgery, surgical critical care, surgical oncology (including head and neck surgery), trauma and emergency surgery, and vascular surgery.
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