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从卫生服务角度看微创机器人二尖瓣修复术后的条件性长期生存

Conditional long-term survival following minimally invasive robotic mitral valve repair: a health services perspective.

作者信息

Efird Jimmy T, Griffin William F, Gudimella Preeti, O'Neal Wesley T, Davies Stephen W, Crane Patricia B, Anderson Ethan J, Kindell Linda C, Landrine Hope, O'Neal Jason B, Alwair Hazaim, Kypson Alan P, Nifong Wiley L, Chitwood W Randolph

机构信息

1 East Carolina Heart Institute, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 2 Center for Health Disparities, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 3 Department of Internal Medicine, Medical University of South Carolina, Charleston, SC, USA ; 4 Department of Pharmacology and Toxicology, Brody School of Medicine, East Carolina University, Greenville, NC, USA ; 5 Department of Internal Medicine, Wake Forest University School of Medicine, Winston-Salem, NC, USA ; 6 Department of General Surgery, University of Virginia School of Medicine, Charlottesville, VA, USA ; 7 The College of Nursing at East Carolina University, Greenville, NC, USA ; 8 Department of Anesthesia, Critical Care, and Pain Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.

出版信息

Ann Cardiothorac Surg. 2015 Sep;4(5):433-42. doi: 10.3978/j.issn.2225-319X.2015.08.08.

Abstract

BACKGROUND

Conditional survival is defined as the probability of surviving an additional number of years beyond that already survived. The aim of this study was to compute conditional survival in patients who received a robotically assisted, minimally invasive mitral valve repair procedure (RMVP).

METHODS

Patients who received RMVP with annuloplasty band from May 2000 through April 2011 were included. A 5- and 10-year conditional survival model was computed using a multivariable product-limit method.

RESULTS

Non-smoking men (≤65 years) who presented in sinus rhythm had a 96% probability of surviving at least 10 years if they survived their first year following surgery. In contrast, recent female smokers (>65 years) with preoperative atrial fibrillation only had an 11% probability of surviving beyond 10 years if alive after one year post-surgery.

CONCLUSIONS

In the context of an increasingly managed healthcare environment, conditional survival provides useful information for patients needing to make important treatment decisions, physicians seeking to select patients most likely to benefit long-term following RMVP, and hospital administrators needing to comparatively assess the life-course economic value of high-tech surgical procedures.

摘要

背景

条件生存被定义为在已存活的年限之外再存活若干年的概率。本研究的目的是计算接受机器人辅助微创二尖瓣修复手术(RMVP)患者的条件生存情况。

方法

纳入2000年5月至2011年4月期间接受带瓣环成形带的RMVP手术的患者。使用多变量乘积限法计算5年和10年条件生存模型。

结果

术后第一年存活的非吸烟男性(≤65岁)且呈窦性心律者,至少存活10年的概率为96%。相比之下,近期吸烟的女性(>65岁)且术前有房颤,术后一年存活者超过10年存活的概率仅为11%。

结论

在日益管理化的医疗环境中,条件生存为需要做出重要治疗决策的患者、寻求选择最有可能从RMVP手术中长期获益的患者的医生以及需要比较评估高科技手术程序的生命历程经济价值的医院管理人员提供了有用信息。

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本文引用的文献

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Concomitant Cox-Maze IV techniques during mitral valve surgery.二尖瓣手术期间的同期Cox迷宫IV技术
Ann Cardiothorac Surg. 2015 Sep;4(5):483-6. doi: 10.3978/j.issn.2225-319X.2014.12.06.
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Minimally invasive mitral valve surgery.微创二尖瓣手术
Ann Cardiothorac Surg. 2015 May;4(3):304. doi: 10.3978/j.issn.2225-319X.2015.05.06.
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Smokeless tobacco, sport and the heart.无烟烟草、运动与心脏
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Robotic mitral valve surgery-current status and future directions.机器人二尖瓣手术:现状与未来方向。
Ann Cardiothorac Surg. 2013 Nov;2(6):814-7. doi: 10.3978/j.issn.2225-319X.2013.10.04.

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