Annual Scientific Session of the American Surgical Association. San Diego, CA, USA, 1999/04.
Objective To examine, in the Veterans Health Administration (VHA), the relation between surgical volume and outcome in eight commonly performed operations of intermediate complexity.
Background Data In multihospital health care systems such as VHA, consideration is often given to closing low-volume surgical services, with the assumption that better surgical outcomes are achieved in hospitals with larger surgical volumes.
Literature data to support this assumption in intermediate-complexity operations are either limited or controversial.
Methods The VHA National Surgical Quality Improvement Program data on nonruptured abdominal aortic aneurysmectomy, vascular infrainguinal reconstruction, carotid endarterectomy (CEA), lung lobectomy/pneumonectomy, open and laparoscopic cholecystectomy, partial colectomy, and total hip arthroplasty were used.
Pearson correlation, analysis of variance, mixed effects hierarchical logistic regression, and automatic interaction detection analysis were used to assess the association of annual procedure/specialty volume with risk-adjusted 30-day death (and stroke in CEA).
Results Eight major surgical procedures (68,631 operations) were analyzed.
No statistically significant associations between procedure or specialty volume and 30-day mortality rate (or 30-day stroke rate in CEA) were found. (...)
Mots-clés Pascal : Chirurgie, Volume distribution, Association, Amélioration procédé, Méthodologie, Etude comparative, Qualité service, Résultat, Article synthèse, Etats Unis, Amérique du Nord, Amérique, Homme, Hôpital, Organisation santé
Mots-clés Pascal anglais : Surgery, Distribution volume, Association, Process improvement, Methodology, Comparative study, Service quality, Result, Review, United States, North America, America, Human, Hospital, Public health organization
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0515170
Code Inist : 002B30A04D. Création : 18/05/2000.