Glance Laurent G, Dick Andrew W, Osler Turner M, Mukamel Dana B
University of Rochester School of Medicine, Rochester, NY, USA.
Chest. 2005 Aug;128(2):829-37. doi: 10.1378/chest.128.2.829.
Off-pump coronary artery bypass graft (CABG) surgery has been recently reintroduced into clinical practice. In light of the relatively low level of experience of most cardiac surgeons with off-pump CABG surgery, and the exceptional technical challenge of working on a "beating heart," off-pump CABG surgery presents a unique opportunity to explore the effect of surgeon case volume on surgical outcome after controlling for the effects of patient case mix and hospital volume.
A retrospective cohort study analyzing the association between surgeon volume and in-hospital mortality rate for off-pump and on-pump CABG surgery using random-effects logistic regression modeling.
The analyses were based on the New York State clinical CABG surgery registry. The study sample consisted of 36,930 patients undergoing isolated CABG surgery between 1998 and 1999 that was performed by 181 surgeons at 33 hospitals.
None.
There is no association between the number of CABG procedures performed off-pump by an individual surgeon and in-hospital mortality rates (p = 0.93) after controlling for hospital CABG surgery volume and patient-level risk factors. There is also no association between the off-pump CABG surgery mortality rate and the total number of both off-pump and on-pump CABG surgery cases (p = 0.78). In the on-pump CABG surgery cohort, surgeons performing a high volume of CABG procedures had significantly lower risk-adjusted mortality rates among their patients compared to those performing a very low volume, a low-volume, and a medium volume of CABG procedures (p < 0.006).
For off-pump CABG surgery, surgeons performing a high volume of procedures do not have better mortality outcomes than those performing a low volume of procedures. However, higher surgeon case volumes are associated with lower mortality rates for on-pump CABG surgery. The absence of a volume-outcome association for off-pump CABG surgery is especially surprising in light of the more technically demanding nature of off-pump CABG surgery compared to on-pump CABG surgery.
非体外循环冠状动脉旁路移植术（CABG）最近重新应用于临床实践。鉴于大多数心脏外科医生对非体外循环CABG手术的经验相对较少，以及在“跳动心脏”上操作面临的特殊技术挑战，非体外循环CABG手术提供了一个独特的机会，可在控制患者病例组合和医院手术量的影响后，探索外科医生手术例数对手术结果的影响。
一项回顾性队列研究，使用随机效应逻辑回归模型分析非体外循环和体外循环CABG手术中外科医生手术量与院内死亡率之间的关联。
分析基于纽约州临床CABG手术登记处的数据。研究样本包括1998年至1999年间在33家医院由181名外科医生进行的36,930例单纯CABG手术患者。
无。
在控制医院CABG手术量和患者层面的风险因素后，个体外科医生进行非体外循环CABG手术的例数与院内死亡率之间无关联（p = 0.93）。非体外循环CABG手术死亡率与非体外循环和体外循环CABG手术病例总数之间也无关联（p = 0.78）。在体外循环CABG手术队列中，与进行极低手术量、低手术量和中等手术量CABG手术的外科医生相比，进行高手术量CABG手术的外科医生其患者的风险调整后死亡率显著更低（p < 0.006）。
对于非体外循环CABG手术，进行高手术量手术的外科医生的死亡率结果并不优于进行低手术量手术的外科医生。然而，外科医生手术例数越高，体外循环CABG手术的死亡率越低。鉴于非体外循环CABG手术相比体外循环CABG手术在技术上要求更高，非体外循环CABG手术缺乏手术量 - 结果关联尤其令人惊讶。
