Effect of procedural volume on the outcomes of congenital heart surgery in Japan
Effect of procedural volume on the outcomes of congenital heart surgery in Japan
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手术体积对日本先天性心脏病手术结果的影响
DOI：
10.1016/j.jtcvs.2022.06.009
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发表时间：
2023
期刊：
影响因子：
--
通讯作者：
Hiro
中科院分区：
文献类型：
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作者：
Naoki Yoshimura ;Yasutaka Hirata ;Ryo Inuzuka ;Hisateru Tachimori ;Akinori Hirano ;Takahisa Sakurai ;Shuichi Shiraishi ;Hikoro Matsui ;Mamoru Ayusawa ;Toshihide Nakano ;Shingo Kasahara ;Yuji Hiramatsu ;Masaaki Yamagishi ;Hiroaki Miyata ;Hiro
本研究建立了一个新的日本先天性心脏病手术风险模型，并利用该模型确定了医院程序量与死亡率之间的关系。方法我们分析了2013-2018年间在日本心血管外科数据库-先天性登记的47,164例手术，并根据日本先天性心脏病手术死亡率的类别和患者特征建立了一个新的风险模型来预测90天/住院死亡率。比较A组[90家医院5539例手术]、B组[24家医院9322例]：51-100例、C组[21家医院13,331例]：101-150例、D组[15家医院18,972例]：≥151例的死亡率。使用手术死亡率类别、年龄体重类别、紧急程度、术前机械通气和肌力调节使用的新风险模型获得了0.81的C-指数。基于新风险模型的观察值/期望值在A、B、C和D组分别为1.37(95%可信区间，1.18-1.58)、1.21(1.08-1.33)、1.04(0.94-1.14)和0.78(0.71-0.86)。A组Rastelli术、缩窄复合体修补术、动脉转换术的观察值/期望值均大于3.0。结论无论是高风险手术还是中风险手术，低流量医院的风险调整死亡率都较高。虽然日本先天性心脏病手术的总体死亡率很低，但观察到的体积-死亡率关系表明手术结果有改进的潜力。
ObjectivesThe present study developed a new risk model for congenital heart surgery in Japan and determined the relationship between hospital procedural volume and mortality using the developed model.MethodsWe analyzed 47,164 operations performed between 2013 and 2018 registered in the Japan Cardiovascular Surgery Database-Congenital and created a new risk model to predict the 90-day/in-hospital mortality using the Japanese congenital heart surgery mortality categories and patient characteristics. The observed/expected ratios of mortality were compared among 4 groups based on annual hospital procedural volume (group A [5539 procedures performed in 90 hospitals]: ≤50, group B [9322 procedures in 24 hospitals]: 51-100, group C [13,331 procedures in 21 hospitals]: 101-150, group D [18,972 procedures in 15 hospitals]: ≥151).ResultsThe overall mortality rate was 2.64%. The new risk model using the surgical mortality category, age-weight categories, urgency, and preoperative mechanical ventilation and inotropic use achieved a c-index of 0.81. The observed/expected ratios based on the new risk model were 1.37 (95% confidence interval, 1.18-1.58), 1.21 (1.08-1.33), 1.04 (0.94-1.14), and 0.78 (0.71-0.86) in groups A, B, C, and D, respectively. In the per-procedure analysis, the observed/expected ratios of the Rastelli, coarctation complex repair, and arterial switch procedures in group A were all more than 3.0.ConclusionsThe risk-adjusted mortality rate for low-volume hospitals was high for not only high-risk but also medium-risk procedures. Although the overall mortality rate for congenital heart surgeries is low in Japan, the observed volume-mortality relationship suggests potential for improvement in surgical outcomes.