Medical City Dallas Hospital, Dallas, Texas, USA.
Ann Thorac Surg. 2012 Apr;93(4):1107-12; discussion 1112-3. doi: 10.1016/j.athoracsur.2011.09.064. Epub 2012 Jan 5.
A volume-outcome association has been shown for cardiovascular procedures such as coronary artery bypass grafting. The association of a volume-outcome relationship for aortic valve replacement procedures, however, has not been clearly defined. We evaluated the influence of surgeon volume on operative outcomes with isolated aortic valve replacement and aortic valve replacement with concomitant coronary artery bypass grafting.
One thousand six hundred thirty-five patients were identified as having either isolated aortic valve replacement or aortic valve replacement plus coronary artery bypass grafting between January 1, 2000, and December 31, 2009. Patients were divided into three equal terciles using their Society of Thoracic Surgery Predicted Risk of Mortality scores. Data were retrieved on 14 surgeons with complete data records in our Society of Thoracic Surgery database covering a minimum 5-year period (mean, 8.9 ± 1.5 years; median, 10 years).
Clinically significant increases are seen in operative mortality, permanent stroke, renal failure, prolonged ventilation, and hospital and intensive care unit lengths of stay in the high-risk compared with low-risk groups. The low-risk patient group has the smallest observed to expected ratio, less than 50%, whereas in the high-risk group the ratio is greater than 1. Odds ratios demonstrate that as surgeon volume increases, outcomes improve correspondingly (ie, odds ratio <1). In low-risk patients, five of ten major complications demonstrated improved outcomes with increased surgeon volume; in medium and high-risk groups eight of ten were improved.
Surgeon volumes have a significant influence on operative outcomes in high-risk patients undergoing aortic valve replacement or aortic valve replacement with coronary artery bypass grafting.
已有研究表明，心血管手术（如冠状动脉旁路移植术）存在量效关系。然而，主动脉瓣置换术的量效关系尚未明确界定。我们评估了外科医生手术量对单纯主动脉瓣置换术和主动脉瓣置换术联合冠状动脉旁路移植术的手术结果的影响。
2000 年 1 月 1 日至 2009 年 12 月 31 日期间，共确定了 1635 例接受单纯主动脉瓣置换术或主动脉瓣置换术联合冠状动脉旁路移植术的患者。根据胸外科协会预测死亡率评分，患者被分为三个相等的三分位数。我们从胸外科协会数据库中检索了 14 位外科医生的数据，这些外科医生的数据记录完整，且覆盖至少 5 年（平均 8.9 ± 1.5 年；中位数 10 年）。
与低危组相比，高危组的手术死亡率、永久性中风、肾衰竭、通气延长以及住院和重症监护病房的住院时间均显著增加。低危患者组的观察到的与预期的比值最小，小于 50%，而高危患者组的比值大于 1。比值比表明，随着外科医生手术量的增加，手术结果相应改善（即比值比<1）。在低危患者中，五种主要并发症中的五种随着外科医生手术量的增加而改善；在中危和高危组中，有八种主要并发症得到改善。
外科医生手术量对高危患者行主动脉瓣置换术或主动脉瓣置换术联合冠状动脉旁路移植术的手术结果有显著影响。
