Surgeon and Center Volume Influence on Outcomes After Arterial Switch Operation: Analysis of the STS Congenital Heart Surgery Database
Surgeon and Center Volume Influence on Outcomes After Arterial Switch Operation: Analysis of the STS Congenital Heart Surgery Database
复制标题
DOI：
10.1016/j.athoracsur.2014.04.093
复制
发表时间：
2014-09-01
影响因子：
4.6
通讯作者：
Jacobs, Jeffrey P.
中科院分区：
文献类型：
--
作者：
Karamlou, Tara;Jacobs, Marshall L.;Jacobs, Jeffrey P.
背景。中心体积和外科医生体积对动脉调转手术 (ASO) 后早期结果的相对影响尚不完全清楚。方法。胸外科医生协会先天性心脏手术数据库（2005-2012）中接受 ASO 进行大动脉转位的新生儿被纳入分析。使用调整患者因素和室间隔缺损闭合的多变量逻辑回归来评估年度中心和外科医生手术量以及复合终点（院内死亡率或主要并发症）之间的关系。结果。该研究包括 2,357 名患者（84 个中心，155 名外科医生）。年 ASO 中心数量中位数为 4（范围：1 至 18）。年外科医生数量中位数为 2（范围：0.1 至 11）。院内死亡率为 3.4%； 14.7% 的患者患有严重疾病，15.5% 的患者达到了复合终点。单独分析，较低的中心和外科医生数量均与复合终点相关（每年 2 例与 10 例中心的优势比为 1.92；95% 置信区间为 1.23 至 2.99）；外科医生每年处理 1 例病例与 6 例病例的比值比为 2.16； 95% 置信区间，1.42 至 3.26）。当一起分析时，将外科医生体积添加到中心体积模型中会减弱，但并没有完全减轻中心体积与结果的关联（比值比的相对减弱 = 31%）。将中心体积添加到外科医生体积模型中，在较小程度上减弱了外科医生体积与结果的关联（比值比的相对衰减= 11%）。结论。中心和外科医生的数量都会影响 ASO 后的早期结果；然而，外科医生的数量似乎发挥着更重要的作用。外科医生和中心的 ASO 体积应在改善大动脉转位 ASO 效果的举措中予以考虑。 (C) 2014 年，胸外科医师协会
Background. The relative impact of center volume and of surgeon volume on early outcomes after the arterial switch operation (ASO) is incompletely understood.Methods. Neonates in the Society of Thoracic Surgeons Congenital Heart Surgery Database (2005-2012) undergoing ASO for transposition of the great arteries were included in the analysis. Multivariable logistic regression with adjustment for patient factors and ventricular septal defect closure was used to evaluate relationships between annual center and surgeon volume and a composite end point (in-hospital mortality or major complications).Results. The study included 2,357 patients (84 centers, 155 surgeons). Median annual ASO center volume was 4 (range, 1 to 18). Median annual surgeon volume was 2 (range, 0.1 to 11). In-hospital mortality was 3.4%; 14.7% had major morbidity and 15.5% met the composite end point. Analyzed individually, lower center and surgeon volumes were each associated with the composite end point (odds ratios for centers with 2 versus 10 cases/y, 1.92; 95% confidence interval, 1.23 to 2.99); odds ratios for surgeons with 1 versus 6 cases/y, 2.16; 95% confidence interval, 1.42 to 3.26). When analyzed together, the addition of surgeon volume to the center volume models attenuated but did not completely mitigate the association of center volume with outcome (relative attenuation of odds ratio = 31%). Addition of center volume to surgeon volume models attenuated the association of surgeon volume with outcome to a lesser degree (relative attenuation of odds ratio = 11%).Conclusions. Center and surgeon volume each influence early outcomes after ASO; however, surgeon volume appears to play a more prominent role. Surgeon and center ASO volume should be considered in the context of initiatives to improve outcomes from ASO for transposition of the great arteries. (C) 2014 by The Society of Thoracic Surgeons