Shah Neeraj, Chothani Ankit, Agarwal Vratika, Deshmukh Abhishek, Patel Nileshkumar, Garg Jalaj, Badheka Apurva, Martinez Matthew, Islam Nauman, Freudenberger Ronald
Department of Cardiology, Lehigh Valley Health Network, Allentown, Pennsylvania.
Department of Cardiology, Mount Sinai St. Luke's Roosevelt Hospital, New York, New York.
J Card Fail. 2016 Mar;22(3):232-7. doi: 10.1016/j.cardfail.2015.10.016. Epub 2015 Nov 4.
There are few data in the literature regarding impact of annual hospital volume on outcomes such as mortality and length of stay (LOS) post-LVAD implantation.
We queried the nationwide inpatient sample from 2008 to 2011 using International Classification of Diseases, 9th Revision procedure code 37.66. We included patients ≥18 years without primary diagnosis of orthotopic heart transplant. Annual volume of LVAD implantation was computed for each hospital. Multivariable hierarchical mixed effect logistic regression models were used to determine predictors of in-hospital mortality and LOS.
There were 1749 LVAD implants from 2008 to 2011; patients had a mean age of 55.4 years, and 23% were female. In-hospital mortality decreased from 20.9% in the first tertile (1-22 LVADs/y) to 13.7% in the third tertile (≥35 LVADs/y) of hospital volume. Median LOS decreased from 34 days in the first tertile to 28 days in third tertile of hospital volume. The adjusted odds ratios of the highest tertile of hospital volume in predicting in-hospital mortality and LOS were 0.41 (0.26-0.64, P < .001) and 0.41 (0.23-0.73, P = .003), respectively. Restricted cubic spline analysis showed that a volume threshold of >20 LVADs/year was associated with favorable mortality rates of <10%.
High annual LVAD volume is associated with significantly decreased in-hospital mortality and LOS after LVAD implantation. Center experience is an important determinant of optimal patient outcomes.
文献中关于每年医院手术量对左心室辅助装置（LVAD）植入术后死亡率和住院时间（LOS）等结局的影响的数据较少。
我们使用国际疾病分类第九版手术编码37.66查询了2008年至2011年的全国住院患者样本。我们纳入了年龄≥18岁且未将原位心脏移植作为主要诊断的患者。计算了每家医院每年的LVAD植入量。使用多变量分层混合效应逻辑回归模型来确定住院死亡率和住院时间的预测因素。
2008年至2011年共进行了1749例LVAD植入手术；患者的平均年龄为55.4岁，23%为女性。住院死亡率从医院手术量第一三分位数（每年1 - 22例LVAD植入）的20.9%降至第三三分位数（每年≥35例LVAD植入）的13.7%。住院时间中位数从医院手术量第一三分位数的34天降至第三三分位数的28天。医院手术量最高三分位数预测住院死亡率和住院时间的调整优势比分别为0.41（0.26 - 0.64，P <.001）和0.41（0.23 - 0.73，P =.003）。受限立方样条分析表明，每年LVAD植入量>20例的阈值与<10%的良好死亡率相关。
每年较高的LVAD植入量与LVAD植入术后住院死亡率和住院时间显著降低相关。中心经验是患者获得最佳结局的重要决定因素。
