The “practice makes perfect” concept considers the more frequent a hospital performs a procedure, the better the outcome of the procedure. We aimed to study this concept by investigating whether patient outcomes improve in hospitals with a significantly increased volume of high-risk surgery over time and whether a learning effect existed at the individual hospital level. We included all patients who underwent one of 10 digestive, cardiovascular and orthopaedic procedures between 2010 and 2014 from the French nationwide hospitals database. For each procedure, we identified three groups of hospitals according to volume trend (increased, decreased, or no change). In-hospital mortality, reoperation, and unplanned hospital readmission within 30 days were compared between groups using Cox regressions, taking into account clustering of patients within hospitals and potential confounders. Individual hospital learning effect was investigated by considering the interaction between hospital groups and procedure year. Over 5 years, 759,928 patients from 694 hospitals were analysed. Patients’ mortality in hospitals with procedure volume increase or decrease over time did not clearly differ from those in hospitals with unchanged volume across the studied procedures (e.g., Hazard Ratios [95%] of 1.04 [0.93–1.17] and 1.08 [0.97–1.21] respectively for colectomy). Furthermore, patient outcomes did not improve or deteriorate in hospitals with increased or decreased volume of procedures over time (e.g., 1.01 [0.95–1.08] and 0.99 [0.92–1.05] respectively for colectomy). Trend in hospital volume over time did not appear to influence patient outcomes based on real-world data. NCT02788331, June 2, 2016.

中文翻译：

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随时间推移医院流量趋势对高风险手术患者预后的影响

“实践完美”的概念认为，医院执行手术的频率越高，手术的效果就越好。我们的目的是通过调查高风险手术量随时间推移而显着增加的医院的患者预后是否有所改善以及各个医院是否存在学习效果来研究这一概念。我们纳入了法国全国医院数据库中2010年至2014年期间接受10种消化，心血管和骨科手术之一的所有患者。对于每种程序，我们根据数量趋势（增加，减少或不变）确定了三组医院。使用Cox回归比较各组之间30天内的院内死亡率，再次手术和计划外的住院率，考虑到医院内患者的聚集和潜在的混杂因素。通过考虑医院群体与手术年份之间的相互作用来研究个体医院的学习效果。在5年中，对来自694家医院的759,928名患者进行了分析。在整个研究过程中，随着程序量的增加或减少而随时间推移而增加或减少的医院中的患者死亡率没有明显不同（例如，危险比[95％]为1.04 [0.93-1.17]和1.08 [0.97-1.21]） ]分别用于结肠切除术）。此外，随着时间的推移，随着手术量的增加或减少，患者的结局并没有改善或恶化（例如，结肠切除术分别为1.01 [0.95-1.08]和0.99 [0.92-1.05]）。根据现实世界的数据，随着时间的推移，医院数量的趋势似乎并未影响患者的预后。NCT02788331，2016年6月2日。