Effect of Endovascular Aneurysm Repair on the Volume-Outcome Relationship in Aneurysm Repair
Effect of Endovascular Aneurysm Repair on the Volume-Outcome Relationship in Aneurysm Repair
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DOI：
10.1161/circoutcomes.109.848465
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发表时间：
2009-11-01
影响因子：
6.9
通讯作者：
Thompson, Matt M.
中科院分区：
文献类型：
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作者：
Holt, Peter J. E.;Poloniecki, Jan D.;Thompson, Matt M.
背景-我们的目标是量化2005-2007年间英格兰腹主动脉瘤选择性血管内成形术(EVR)或开放修补术(AAA)的年工作量(量)与预后之间的关系。方法和结果-个体患者数据来自医院事件统计。统计学方法包括多元Logistic回归模型、死亡率控制图和安全曲线图，以确定容量和结果之间任何关系的性质。使用住院死亡率的观察值和期望值检查不同规模医院之间的病例组合。结果指标包括住院死亡率和住院时间。2005至2007年间，英格兰共有57587名被诊断为AAA的患者入院，其中11574人接受了AAA修复。择期AAA修补术7313例，其中开放修补术5668例(78%)，EVR修补术1645例(22%)。所有择期腹主动脉修补术的住院死亡率为5.63%，其中开放修补组为6.18%，体外循环修补组为3.77%(优势比，0.676；95%CI，0.501~0.913；P=0.011)。接受大容量动脉瘤治疗的患者总体死亡率显著降低(0.991；0.988至0.994；P
Background-We aim to quantify the relationship between the annual caseload (volume) and outcome from elective endovascular (EVR) or open repair of abdominal aortic aneurysms (AAAs) in England between 2005 and 2007.Methods and Results-Individual patient data were obtained from the Hospital Episode Statistics. Statistical methods included multiple logistic regression models, mortality control charts, and safety plots to determine the nature of any relationship between volume and outcome. The case-mix between hospitals of different sizes was examined using observed and expected values for in-hospital mortality. Outcome measures included in-hospital mortality and hospital length of stay. Between 2005 and 2007, a total of 57 587 patients were admitted to hospitals in England with a diagnosis of AAA, and 11 574 underwent AAA repair. There were 7313 elective AAA repairs, of which 5668 (78%) were open and 1645 (22%) were EVR. In-hospital mortality rates were 5.63% for all elective AAA repairs with rates of 6.18% for open repair and 3.77% for EVR (odds ratio, 0.676; 95% CI, 0.501 to 0.913; P=0.011). High-volume aneurysm services were associated with significantly lower mortality rates overall (0.991; 0.988 to 0.994; P