Vassileva Christina, DiGennaro Joshua, Boley Theresa, Markwell Stephen, Hazelrigg Stephen
Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, 701 N. First St., Room D318, Springfield, IL 62794-9638, USA.
J Heart Valve Dis. 2012 Jan;21(1):48-55.
There is paucity of data relating to the geographic variation in mitral valve (MV) repair trends and outcomes of patients undergoing MV surgery.
Using the 2005-2008 Nationwide Inpatient Sample (NIS) Database, the four geographic regions of the US (Northeast, Midwest, South, and West) were compared with respect to baseline characteristics, mitral procedure selection, and hospital mortality of patients undergoing either MV repair (ICD-9CM code 35.12) or replacement (ICD-9-CM codes 35.23 and 35.24).
Patient age was similar across regions. The Midwest had the highest proportion of whites, while patients in the South were the least affluent. The Northeast had the highest proportion of patients presenting non-electively. The West and Midwest had more women and patients with private insurance compared to the South, but the proportion of patients on Medicaid was similar across all regions. The Northeast and the South had a higher Charlson Comorbidity Index compared to the West. The overall repair rate was 47%; the Midwest had the highest rate (50%), and the South the lowest (42%) (p = NS). Following adjustment for baseline characteristics, hospital mortality was similar among regions for patients undergoing MV replacement. For the subset undergoing MV repair, hospital mortality was more than 2.5-fold higher in the South than in the Northeast (OR = 2.88, 95% CI 1.45-5.71).
MV repair is utilized in less than half of all mitral procedures nationwide. Repair rates and hospital mortality are comparable across all four regions in the US. Hospital mortality for isolated MV surgery is low. The higher adjusted mortality for patients undergoing MV repair in the South identifies an important area for future improvement in the care of patients with valvular heart disease.
关于二尖瓣（MV）修复趋势的地理差异以及接受MV手术患者的结局的数据较少。
利用2005 - 2008年全国住院患者样本（NIS）数据库，对美国的四个地理区域（东北部、中西部、南部和西部）在接受MV修复（国际疾病分类第九版临床修正本代码35.12）或置换（国际疾病分类第九版临床修正本代码35.23和35.24）患者的基线特征、二尖瓣手术选择和医院死亡率方面进行比较。
各地区患者年龄相似。中西部白人比例最高，而南部患者最不富裕。东北部非择期就诊患者比例最高。与南部相比，西部和中西部女性及有私人保险的患者更多，但各地区接受医疗补助的患者比例相似。东北部和南部的查尔森合并症指数高于西部。总体修复率为47%；中西部修复率最高（50%），南部最低（42%）（p = 无显著差异）。在对基线特征进行调整后，接受MV置换的患者各地区医院死亡率相似。对于接受MV修复的亚组，南部的医院死亡率比东北部高2.5倍以上（比值比 = 2.88，95%可信区间1.45 - 5.71）。
在全国所有二尖瓣手术中，MV修复的使用率不到一半。美国所有四个地区的修复率和医院死亡率相当。单纯MV手术的医院死亡率较低。南部接受MV修复患者调整后死亡率较高，这确定了瓣膜性心脏病患者护理未来改善的一个重要领域。
