Risk-Adjusted Analyses of the Effects of Hospital and Surgeon Volumes on Postoperative Complications and the Modified Rankin Scale After Clipping of Unruptured Intracranial Aneurysms in Japan
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概要
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The present study conducted risk-adjusted analyses to investigate the impacts of hospital and surgeon volumes on postoperative complications and the modified Rankin scale (mRS) after intracranial clipping of unruptured aneurysms, and to discuss the efficacy of relevant policy changes. Among 107 Japanese institutions, physician-reported data for 702 unruptured aneurysm patients were registered between December 2006 and April 2007. Postoperative complications and the mRS at the time of discharge were independently regressed against hospital and surgeon volumes, aneurysm size, aneurysm location, and comorbidities. Aneurysm size was a significant predictor of the overall outcomes. After adjusting for prominent confounders, hospital volume did not show any significant associations with postoperative complications (odds ratio [OR] 0.75, 95% confidence interval [CI] 0.34-1.68, p=0.49) or the mRS (OR 0.60, 95% CI 0.19-1.93, p=0.39). Higher surgeon volume (≥100) was associated with lower mRS scores (OR 0.40, 95% CI 0.20-0.83, p=0.013), but had no significant relationship with postoperative complications (OR 0.72, p=0.47). Our risk-adjusted analyses showed no significant relationships between hospital volume and comorbidities. Therefore, the justification for hospital volume-based policies remains unclear. Prospective risk-adjusted volume-based studies are required for future evidence-based referral policies.
- 社団法人日本脳神経外科学会の論文
- 2008-12-15
著者
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Yasunaga Hideo
Department of Health Management and Policy, Graduate School of Medicine, The University of Tokyo
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Ohe Kazuhiko
Department of Medical Informatics and Economics, Graduate School of Medicine, The University of Toky
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Ohe Kazuhiko
Department Of Medical Informatics And Economics Graduate School Of Medicine University Of Tokyo
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MATSUYAMA Yutaka
Department of Biostatistics, Graduate School of Medicine, University of Tokyo
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Yasunaga Hideo
Department Of Health Management And Policy Graduate School Of Medicine University Of Tokyo
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Yasunaga Hideo
Department Of Health Management And Policy (h.horiguchi H.y.) Graduate School Of Medicine University
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OCHIAI Kazunori
Department of Obstetrics and Gynecology, Jikei University School of Medicine
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Ochiai Kazunori
Department Of Obstetrics And Gynecology Jikei University School Of Medicine
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Matsuyama Yutaka
Department Of Biostatistics School Of Public Health University Of Tokyo
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Matsuyama Yutaka
Department Of Biostatistics / Epidemiology And Preventive Health Sciences School Of Health Sciences
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Ohe Kazuhiko
Department of Health Informatics, The University of Tokyo
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