Background: 

Quality leaders are concerned that creation of multi-hospital health systems may lead to surgeons traveling to and from distant hospitals and thus to more fragmented surgical care and worse outcomes for their patients. Despite this concern, little empirical data exist on outcomes of multi-site versus single-site surgeons.

Methods: 

Using national Medicare data, we assessed trends in the number of multi-site vs. single-site surgeons from 2011 to 2016. We performed a multivariable regression analysis to compare overall 30-day mortality differences, stratified by system and rural status, and examined trends over time.

Results: 

The number of multi-site surgeons and the percentage of multi-site surgeons per hospital decreased over time (24.2%–19.0%; 44.3%–41.8%). Overall, multi-site surgeons had lower 30-day mortality than single-site surgeons (2.24% vs 2.50%, P < 0.01). When stratified by system status, multi-site surgeons performed better in-system (2.47% vs 2.58%, P < 0.01); by rural status, multi-site surgeons had lower mortality in non-rural hospitals (2.42% vs 2.51%, P < 0.01). The statistically significant but small mortality advantage of multi-site versus single-site surgeons decreased over time, such that by 2016 there was no difference in outcomes between multi-site and single-site surgeons.

Conclusion: 

For the majority of study years, multi-site surgeons had lower 30-day mortality than single-site surgeons, but this trend narrowed until outcomes were equivalent by 2016. Surgeons operating at multiple hospitals can provide surgical care to patients without any evidence of increased mortality.

中文翻译：

---

多中心和单中心外科医生 30 天死亡率的纵向趋势

背景： 

质量领导者担心，建立多医院卫生系统可能会导致外科医生往返于遥远的医院，从而导致手术护理更加分散，患者的治疗效果更差。尽管存在这种担忧，但关于多部位外科医生与单部位外科医生结果的实证数据很少。

方法： 

使用国家医疗保险数据，我们评估了 2011 年至 2016 年多点外科医生与单点外科医生数量的趋势。我们进行了多变量回归分析，以比较 30 天死亡率的总体差异，按系统和农村状况分层，并检查随着时间的推移趋势。

结果： 

随着时间的推移（24.2%–19.0%；44.3%–41.8%），每家医院的多点外科医生数量和多点外科医生的百分比有所下降。总体而言，多部位外科医生的 30 天死亡率低于单部位外科医生（2.24% 对 2.50%，P < 0.01）。当按系统状态分层时，多站点外科医生在系统内表现更好（2.47% 对 2.58%，P < 0.01）；从农村状况来看，多点外科医生在非农村医院的死亡率较低（2.42% vs 2.51%，P < 0.01）。随着时间的推移，多部位外科医生与单部位外科医生的统计显着但死亡率优势较小，因此到 2016 年多部位外科医生和单部位外科医生之间的结果没有差异。

结论： 

在大多数研究年中，多中心外科医生的 30 天死亡率低于单中心外科医生，但这一趋势逐渐缩小，直到 2016 年结果相当。死亡。