Department of Outcomes Research, St George's Vascular Institute, St George's Healthcare NHS Trust, London SW17 0QT, UK.
Br J Surg. 2012 May;99(5):666-72. doi: 10.1002/bjs.8696. Epub 2012 Feb 17.
Robust risk-adjusted analyses have demonstrated that a reduction in perioperative mortality is associated with the repair of an abdominal aortic aneurysm (AAA) in centres with a high operative caseload (volume). However, the long-term impact of this volume-related effect on mortality remains unknown.
Demographic and clinical data were extracted from UK Hospital Episodes Statistics for patients undergoing elective repair of an infrarenal AAA from 1 April 2000 to 31 March 2005. The long-term mortality of this cohort was investigated through linkage to the UK Office for National Statistics (ONS) registry. Risk-adjusted survival was analysed using Cox proportional hazards modelling to identify the effect of hospital volume on long-term mortality.
A total of 14 396 patients with mean age of 72 years, of whom 85.7 per cent were men, underwent elective repair of an infrarenal AAA in England. They were linked to follow-up using ONS data. Risk-adjusted analysis of all-cause mortality by Cox proportional hazards modelling demonstrated a significant effect of hospital volume across all quintiles up to 2 years (P = 0.013). Remodelling the data after excluding in-hospital mortality still demonstrated the significant effect of hospital volume on late outcome.
There is a long-term benefit to patients who undergo elective AAA repair in a high-volume hospital.
强有力的风险调整分析表明，在手术量较大（高容量）的中心进行腹主动脉瘤（AAA）修复与围手术期死亡率的降低相关。然而，这种与容量相关的效果对死亡率的长期影响尚不清楚。
从 2000 年 4 月 1 日至 2005 年 3 月 31 日期间，从英国医院发病统计中提取接受择期修复肾下型 AAA 的患者的人口统计学和临床数据。通过与英国国家统计局（ONS）登记处的链接，调查了该队列的长期死亡率。使用 Cox 比例风险模型分析风险调整后的生存率，以确定医院容量对长期死亡率的影响。
共有 14396 名平均年龄为 72 岁的患者，其中 85.7%为男性，在英格兰接受了择期肾下型 AAA 修复。使用 ONS 数据对他们进行了随访。Cox 比例风险模型对全因死亡率的风险调整分析表明，在所有五分位数中，医院容量对 2 年内的死亡率都有显著影响（P = 0.013）。排除院内死亡率后重新建模数据仍然显示医院容量对晚期结果有显著影响。
在高容量医院接受择期 AAA 修复的患者可获得长期益处。
