美国前庭神经鞘瘤手术结局与医院体积的当代关联
The Contemporary Association of Hospital volume with Outcomes of Surgery for Vestibular Schwannoma in the United States.
文献信息
| PMID | 42854957 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Konmal Ali |
| 作者单位 | Center for Advanced Surgical and Interventional Technology, Department of Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA. |
| 期刊 | World neurosurgery |
| SCI 分区 | Q2 |
| IF | 2.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 耳科 |
中文摘要
背景： 尽管显微外科技术取得了进步，前庭神经鞘瘤（VS）切除术后的围手术期并发症仍然显著。鉴于当代的诊疗模式，我们在一个当代全国性队列中描述了体积-结局关系的存在。
方法： 查询了2013-2022年全国再入院数据库，以识别接受VS切除术的成年人。根据限制性立方样条模型制定的年度阈值，将医院分类为低容量医院（LVH）和高容量医院（HVH）。随后使用多变量逻辑回归评估HVH状态与感兴趣结局的关联，包括主要不良事件（MAE），定义为院内死亡和术后并发症的复合终点。
结果： 在估计的19,883名患者中，13,007名（65%）在HVH接受治疗。HVH中心定义为每年至少进行10例手术的医院。与其他医院相比，HVH的患者更年轻，女性更常见，且属于最高收入四分位数。经过充分的风险调整后，以LVH为参照，在HVH治疗与较低的MAE几率（AOR 0.64，95% CI 0.56-0.73）、面瘫（AOR 0.59，95% CI 0.51-0.68）、吞咽困难（AOR 0.59，95% CI 0.47-0.74）和急性脑血管事件（AOR 0.75，95% CI 0.56-0.98）相关。HVH状态与较短的住院时间（β -1.25天，95% CI -1.55至-0.95）和较低的非家庭出院几率（AOR 0.44，95% CI 0.36-0.55）相关。
结论： HVH状态与较低的MAE几率、降低的术后并发症风险和较短的住院时间相关。改进关于在LVH集中化和VS手术专业知识的政策可能有助于提高整体护理标准。
英文摘要
BACKGROUND: Despite advancements in microsurgical technique, perioperative morbidity following resection for vestibular schwannoma (VS) remains significant. Given contemporary care paradigms, we characterized the presence of a volume-outcome relationship in a contemporary national cohort.
METHODS: The 2013-2022 Nationwide Readmissions Database was queried to identify adults undergoing VS resection. Hospitals were classified as low- (LVH) and high-volume hospitals (HVH), based on annual thresholds developed from restricted cubic spline models. Multivariable logistic regressions were subsequently utilized to evaluate the association of HVH status with outcomes of interest including major adverse events (MAE) defined as a composite of in-hospital mortality and postoperative complications.
RESULTS: Of an estimated 19,883 patients, 13,007 (65%) were treated at HVH. HVH centers were defined as those that performed at least 10 cases annually. Compared to others, HVH were younger, more commonly female, and of the highest income quartile. Following adequate risk adjustment, treatment at HVH was associated with lower odds of MAE (AOR 0.64, 95% CI 0.56-0.73), facial droop (AOR 0.59, 95% CI 0.51-0.68), dysphagia (AOR 0.59, 95% CI 0.47-0.74), and acute cerebrovascular events (AOR 0.75, 95% CI 0.56-0.98) with LVH as reference. HVH status was linked with shorter LOS (β -1.25 days, 95% CI -1.55 to -0.95), and lower odds of nonhome discharge (AOR 0.44, 95% CI 0.36-0.55).
CONCLUSION: HVH status was associated with lower odds of MAE, reduced risk of postoperative complications, and shorter length of stay. Improved policies regarding centralization and surgical expertise of VS at LVH may help enhance overall standard of care.