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Hospital volume-outcome relationships for robot-assisted surgeries: a population-based analysis.
Walker, Richard J B; Stukel, Thérèse A; de Mestral, Charles; Nathens, Avery; Breau, Rodney H; Hanna, Waël C; Hopkins, Laura; Schlachta, Christopher M; Jackson, Timothy D; Shayegan, Bobby; Pautler, Stephen E; Karanicolas, Paul J.
Afiliação
  • Walker RJB; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
  • Stukel TA; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
  • de Mestral C; ICES, Toronto, Canada.
  • Nathens A; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
  • Breau RH; ICES, Toronto, Canada.
  • Hanna WC; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
  • Hopkins L; ICES, Toronto, Canada.
  • Schlachta CM; Division of Vascular Surgery, St. Michael's Hospital, University of Toronto, Toronto, Canada.
  • Jackson TD; Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Canada.
  • Shayegan B; Institute of Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
  • Pautler SE; ICES, Toronto, Canada.
  • Karanicolas PJ; Division of General Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave., Room T2 16, TorontoToronto, ON, M4N 3M5, Canada.
Surg Endosc ; 38(8): 4531-4542, 2024 Aug.
Article em En | MEDLINE | ID: mdl-38937312
ABSTRACT

BACKGROUND:

Associations between procedure volumes and outcomes can inform minimum volume standards and the regionalization of health services. Robot-assisted surgery continues to expand globally; however, data are limited regarding which hospitals should be using the technology. STUDY

DESIGN:

Using administrative health data for all residents of Ontario, Canada, this retrospective cohort study included adult patients who underwent a robot-assisted radical prostatectomy (RARP), total robotic hysterectomy (TRH), robot-assisted partial nephrectomy (RAPN), or robotic portal lobectomy using 4 arms (RPL-4) between January 2010 and September 2021. Associations between yearly hospital volumes and 90-day major complications were evaluated using multivariable logistic regression models adjusted for patient characteristics and clustering at the level of the hospital.

RESULTS:

A total of 10,879 patients were included, with 7567, 1776, 724, and 812 undergoing a RARP, TRH, RAPN, and RPL-4, respectively. Yearly hospital volume was not associated with 90-day complications for any procedure. Doubling of yearly volume was associated with a 17-min decrease in operative time for RARP (95% confidence interval [CI] - 23 to - 10), 8-min decrease for RAPN (95% CI - 14 to - 2), 24-min decrease for RPL-4 (95% CI - 29 to - 19), and no significant change for TRH (- 7 min; 95% CI - 17 to 3).

CONCLUSION:

The risk of 90-day major complications does not appear to be higher in low volume hospitals; however, they may not be as efficient with operating room utilization. Careful case selection may have contributed to the lack of an observed association between volumes and complications.
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Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Prostatectomia / Hospitais com Alto Volume de Atendimentos / Hospitais com Baixo Volume de Atendimentos / Procedimentos Cirúrgicos Robóticos / Nefrectomia Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: Surg Endosc Assunto da revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Canadá

Texto completo: 1 Coleções: 01-internacional Base de dados: MEDLINE Assunto principal: Complicações Pós-Operatórias / Prostatectomia / Hospitais com Alto Volume de Atendimentos / Hospitais com Baixo Volume de Atendimentos / Procedimentos Cirúrgicos Robóticos / Nefrectomia Limite: Adult / Aged / Female / Humans / Male / Middle aged País/Região como assunto: America do norte Idioma: En Revista: Surg Endosc Assunto da revista: DIAGNOSTICO POR IMAGEM / GASTROENTEROLOGIA Ano de publicação: 2024 Tipo de documento: Article País de afiliação: Canadá