https://scholars.lib.ntu.edu.tw/handle/123456789/543879
標題: | Volume-Outcome Relation for Acute Appendicitis: Evidence from a Nationwide Population-Based Study | 作者: | Wei P.-L. SHIH-PING LIU Keller J.J. Lin H.-C. |
公開日期: | 2012 | 卷: | 7 | 期: | 12 | 起(迄)頁: | e52539 | 來源出版物: | PLoS ONE | 摘要: | Background: Although procedures like appendectomy have been studied extensively, the relative importance of each surgeon's surgical volume-to-ruptured appendicitis has not been explored. The purpose of this study was to investigate the rate of ruptured appendicitis by surgeon-volume groups as a measure of quality of care for appendicitis by using a nationwide population-based dataset. Methods: We identified 65,339 first-time hospitalizations with a discharge diagnosis of acute appendicitis (International Classification of Disease, Ninth Revision, Clinical Modification (ICD-9-CM) codes 540, 540.0, 540.1 and 540.9) between January 2007 and December 2009. We used "whether or not a patient had a perforated appendicitis" as the outcome measure. A conditional (fixed-effect) logistic regression model was performed to explore the odds of perforated appendicitis among surgeon case volume groups. Results: Patients treated by low-volume surgeons had significantly higher morbidity rates than those treated by high-volume (28.1% vs. 26.15, p<0.001) and very-high-volume surgeons (28.1% vs. 21.4%, p<0.001). After adjusting for surgeon practice location, and teaching status of practice hospital, and patient age, gender, and Charlson Comorbidity Index, and hospital acute appendicitis volume, patients treated by low-volume surgeons had significantly higher rates of perforated appendicitis than those treated by medium-volume surgeons (OR = 1.09, p<0.001), high-volume surgeons (OR = 1.16, p<0.001), or very-high-volume surgeons (OR = 1.54, p<0.001). Conclusion: Our study suggested that surgeon volume is an important factor with regard to the rate of ruptured appendicitis. ? 2012 Wei et al. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-84871591090&doi=10.1371%2fjournal.pone.0052539&partnerID=40&md5=b539d6b8d38dc9deed31ffcaf4063750 https://scholars.lib.ntu.edu.tw/handle/123456789/543879 |
ISSN: | 1932-6203 | DOI: | 10.1371/journal.pone.0052539 | SDG/關鍵字: | acute appendicitis; adult; age; appendix perforation; article; Charlson Comorbidity Index; controlled study; evidence based medicine; female; gender; health care quality; human; major clinical study; male; morbidity; population research; statistical analysis; teaching hospital; treatment outcome; urban rural difference; volume outcome relation; Acute Disease; Adolescent; Adult; Aged; Aged, 80 and over; Appendectomy; Appendicitis; Child; Child, Preschool; Female; Humans; Male; Middle Aged; Regression Analysis; Rupture; Taiwan; Treatment Outcome |
顯示於: | 醫學系 |
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