Toward quality improvement of thoracic aortic surgery: estimating volume-outcome effect from nationwide survey
Toward quality improvement of thoracic aortic surgery: estimating volume-outcome effect from nationwide survey
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DOI：
10.1016/j.ejcts.2009.03.020
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发表时间：
2009-09-01
影响因子：
3.4
通讯作者：
Takamoto, Shinichi
中科院分区：
文献类型：
--
作者：
Miyata, Hiroaki;Motomura, Noboru;Takamoto, Shinichi
背景：尽管了解手术量与结果之间的关系一直是许多研究的焦点，但尚未有研究报告胸主动脉手术的体积与结果的影响。方法：我们从临床数据库中识别并分析了 2003 年至 2005 年间在 36 个中心进行的 2875 例手术。使用分层混合效应逻辑回归模型评估了医院手术量对每个结果指标的影响。临床危险因素、手术年份、临床流程、置换范围、医院规模和外科医生数量被设置为固定效应，地点被用作随机截距。结果：逻辑回归模型显示，医院胸主动脉手术量与 30 天死亡率（p = 0.127：OR 0.988-0.999）和手术死亡率（p = 0.022：0.989-0.999）的统计显着下降相关。此外，亚组分析显示，医院容量的增加与 65 岁以下患者 (p = 0.038: 0.982-0.999) 和高风险手术候选人 (p = 0.019: 0.989-0.999) 死亡率的降低相关。外科医生的胸主动脉手术量、医院成人心血管手术量和外科医生成人心血管手术量对这些结果没有显着影响。结论：在这项研究中，医院每年医院胸主动脉手术量的增加与胸主动脉手术死亡率的降低相关。在日本，胸主动脉手术质量指标可能更适合的不是医院一般成人心血管手术量，而是医院特定胸主动脉手术量。 (C) 2009 年欧洲心胸外科协会。由 Elsevier B.V. 出版。保留所有权利。
Background: Although understanding the association between surgical volume and outcome has been the focus of much research, no study has yet reported the volume-outcome effect for thoracic aortic surgery. Methods: From the clinical database we identified and analyzed 2875 procedures that took place across 36 centers between 2003 and 2005. The effect of hospital procedural volume was assessed for each outcome measure using a hierarchical mixed-effects logistic regression model. Clinical risk factors, procedural year, clinical processes, range of replacement, hospital volume and surgeon volume were set as fixed effects and sites were used as random intercepts. Results: The logistic regression model revealed that hospital thoracic aortic surgery volume was linked to statistically significant decreases in both 30-day mortality (p = 0.127: OR 0.988-0.999) and operative mortality (p = 0.022: 0.989-0.999). In addition, subgroup analysis showed that increased hospital volume was associated with reduced mortality rates in patients under 65 years of age (p = 0.038: 0.982-0.999) and in high-risk surgical candidates (p = 0.019: 0.989-0.999). Thoracic aortic surgery volume of surgeons, hospital adult cardiovascular surgery volume and surgeons adult cardiovascular surgery volume did not significantly impact these outcomes. Conclusions: In this study higher annual hospital thoracic aortic surgery volume of hospitals is associated with reduced mortality rates for thoracic aortic surgery. In Japan it is not the hospital general adult cardiovascular surgery volume, but the hospital specific thoracic aortic surgery volume that might be preferable for quality indicator of thoracic aortic surgery. (C) 2009 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.