Welch Brian T, Brinjikji Waleed, Schmit Grant D, Kurup A Nicholas, El-Sayed Abdulrahman M, Cloft Harry J, Thompson R Houston, Callstrom Matthew R, Atwell Thomas D
Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
Department of Radiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905.
J Vasc Interv Radiol. 2015 Mar;26(3):342-7. doi: 10.1016/j.jvir.2014.10.022. Epub 2014 Dec 18.
To perform a national analysis of safety, charges, complications, and mortality of percutaneous image-guided renal thermal ablation and compare outcomes by hospital volume.
Using the Nationwide Inpatient Sample, trends in the proportion of inpatient percutaneous renal thermal ablation procedures performed at high-volume centers in the United States from 2007-2011 were evaluated. In-hospital mortality, discharge to long-term care facility, length of stay, hospitalization charges, and postoperative complications were compared between high-volume and low-volume ablation centers. High volume was set at the 90th percentile for renal thermal ablation volume, which equated to seven or more patients per year. A multivariate logistic regression analysis adjusting for hospital volume, age, sex, Charlson Comorbidity Index, obesity, race, and insurance status was performed to analyze the influence of hospital volume on the above-listed outcomes.
This study included 874 patients. The number of hospitals ranged from 59-77 depending on year. Overall, 328 patients (37.5%) were treated at high-volume ablation centers. The proportion of patients treated at high-volume centers decreased from 42.0% in 2007-2009 to 28.5% in 2010-2011. High-volume hospitals also performed significantly more partial nephrectomies than low-volume hospitals. On multivariate logistic regression analysis, increasing hospital volume was associated with lower odds of in-hospital mortality (odds ratio [OR] = 0.31, 95% confidence interval [CI] = 0.02-0.95) and lower odds of discharge to a long-term care facility (OR = 0.00, 95% CI = 0.00-0.66). Increasing hospital volume was also associated with lower odds of blood transfusion (OR = 0.84, 95% CI = 0.72-0.94). Length of stay decreased with increasing hospital volume (P = .03).
Patient safety may be maximized when renal ablation is performed at high-volume centers as a result of both greater procedural experience and potentially multidisciplinary triage and periprocedural management.
对经皮影像引导下肾热消融术的安全性、费用、并发症及死亡率进行全国性分析，并按医院手术量比较结果。
利用全国住院患者样本，评估2007 - 2011年美国高手术量中心进行的住院患者经皮肾热消融术比例的趋势。比较高手术量和低手术量消融中心的院内死亡率、转至长期护理机构情况、住院时间、住院费用及术后并发症。高手术量设定为肾热消融手术量的第90百分位数，即每年7例或更多患者。进行多因素逻辑回归分析，对医院手术量、年龄、性别、Charlson合并症指数、肥胖、种族和保险状况进行校正，以分析医院手术量对上述结果的影响。
本研究纳入874例患者。医院数量根据年份在59 - 77家之间。总体而言，328例患者（37.5%）在高手术量消融中心接受治疗。在高手术量中心接受治疗的患者比例从2007 - 2009年的42.0%降至2010 - 2011年的28.5%。高手术量医院进行的部分肾切除术也明显多于低手术量医院。多因素逻辑回归分析显示，医院手术量增加与院内死亡率降低（优势比[OR]=0.31，95%置信区间[CI]=0.02 - 0.95）及转至长期护理机构的几率降低（OR = 0.00，95% CI = 0.00 - 0.66）相关。医院手术量增加还与输血几率降低（OR = 0.84，95% CI = 0.72 - 0.94）相关。住院时间随医院手术量增加而缩短（P = 0.03）。
由于手术经验更丰富以及可能的多学科分诊和围手术期管理，在高手术量中心进行肾消融时，患者安全性可能会最大化。
