Division of Cardiac Surgery, Department of Surgery, The Johns Hopkins Medical Institutions, Baltimore, MD 21287, USA.
J Thorac Cardiovasc Surg. 2012 Dec;144(6):1502-8; discussion 1508-9. doi: 10.1016/j.jtcvs.2012.08.047. Epub 2012 Sep 17.
The aim of this study was to evaluate the effect of center volume on the incidence of postoperative complications and their impact on survival after lung transplantation (LTx).
United Network for Organ Sharing data were used to identify adult patients undergoing LTx between 1999 and 2009. Center volume was modeled as both a continuous and a categorical variable. Postoperative complications included infection, rejection, stroke, reoperation, and renal failure requiring dialysis. Multivariable Cox regression and Kaplan-Meier analyses were conducted after stratification on the basis of center volume and type of complication.
A total of 12,565 LTx recipients were included in the study. Overall rates of postoperative complications were 5.4% for renal failure requiring dialysis, 1.9% for stroke, 19.9% for reoperation, 42.8% for infection, and 10.0% for rejection. High volume centers did not have significantly reduced rates of postoperative complications. Risk-adjusted multivariable Cox analysis demonstrated that in patients with a complication, low volume center was a significant risk factor for increased 90-day, 1-year, and 5-year mortality. Kaplan-Meier analyses similarly demonstrated reduced posttransplant survival in lower volume centers, a finding that persisted after stratification based on individual complication type except for stroke.
Although high volume centers do not have significantly lower incidences of individual postoperative complications after LTx, they are best able to minimize the adverse effects of these complications on short- and long-term survival. These data suggest that identifying and implementing the institutional practices that lead to better management of postoperative complications after LTx in high volume centers may be prudent to improving outcomes in lower volume hospitals.
本研究旨在评估中心容量对肺移植（LTx）后术后并发症发生率及其对生存的影响。
使用联合器官共享网络数据确定 1999 年至 2009 年期间接受 LTx 的成年患者。将中心容量建模为连续变量和分类变量。术后并发症包括感染、排斥、中风、再次手术和需要透析的肾衰竭。在基于中心容量和并发症类型分层的基础上，进行多变量 Cox 回归和 Kaplan-Meier 分析。
本研究共纳入 12565 例 LTx 受者。需要透析的肾衰竭、中风、再次手术、感染和排斥的术后并发症总发生率分别为 5.4%、1.9%、19.9%、42.8%和 10.0%。高容量中心的术后并发症发生率没有显著降低。风险调整后的多变量 Cox 分析表明，在有并发症的患者中，低容量中心是 90 天、1 年和 5 年死亡率增加的显著危险因素。Kaplan-Meier 分析同样表明，低容量中心的移植后生存率降低，这一发现在基于个体并发症类型分层后仍然存在，除了中风。
尽管高容量中心在 LTx 后个体术后并发症的发生率没有显著降低，但它们能够最大限度地减少这些并发症对短期和长期生存的不利影响。这些数据表明，在高容量中心确定并实施导致术后并发症更好管理的机构实践，可能有助于改善低容量医院的结局。
