Kansy Andrzej, Ebels Tjark, Schreiber Christian, Jacobs Jeffrey P, Tobota Zdzislaw, Maruszewski Bohdan
1The Children's Memorial Health Institute,Warsaw,Poland.
2University Medical Center Groningen,Groningen,the Netherlands.
Cardiol Young. 2015 Dec;25(8):1572-8. doi: 10.1017/S1047951115002073.
Previous analyses have suggested an association between centre volume and in-hospital mortality, post-operative complications, and mortality in those patients who suffer from a complication. We sought to determine the nature of this association using a multicentre cohort.
All the patients, aged 18 years or younger, undergoing heart surgery at centres participating in the European Congenital Heart Surgeons Database (2003-2013) were included. Programmes were grouped as follows: small 350. Multivariable logistic regression was used to identify the differences between groups with the adjusted in-hospital mortality, onset of any and/or major complication, and in-hospital mortality in those patients with any and/or major complication. The outcomes were adjusted for patient specific risk factors and surgical risk factors.
The data set consisted of 119,345 procedures performed in 99 centres. Overall, in-hospital mortality was 4.63%; complications occurred in 23.4% of the patients. In-hospital mortality in patients with complications was 13.82%. Multivariable logistic regression showed that the risk of in-hospital death was higher in low- and medium-volume centres (p<0.001). The rate of the occurrence of any post-operative complication in small, medium, and large programmes was lower compared with very large centres (p<0.001). Low- and medium-volume centres were associated with significantly higher mortality in patients with any complication (p<0.001).
Our analysis showed that the risk of in-hospital mortality was lower in higher-volume centres. Although the risk of complications is higher in high-volume centres, the mortality associated with complications that occurred in these centres was lower.
既往分析提示，中心手术量与住院死亡率、术后并发症以及发生并发症患者的死亡率之间存在关联。我们试图通过一项多中心队列研究来确定这种关联的性质。
纳入所有在参与欧洲先天性心脏病外科医生数据库（2003 - 2013年）的中心接受心脏手术的18岁及以下患者。项目分组如下：小手术量中心（每年手术量＜100例）、中等手术量中心（每年手术量100 - 350例）、大手术量中心（每年手术量＞350例）以及超大手术量中心（每年手术量＞600例）。多变量逻辑回归用于确定不同组之间在调整后的住院死亡率、任何和/或主要并发症的发生情况以及发生任何和/或主要并发症患者的住院死亡率方面的差异。对患者特定风险因素和手术风险因素进行了结果调整。
数据集包括99个中心进行的119345例手术。总体而言，住院死亡率为4.63%；23.4%的患者发生了并发症。发生并发症患者的住院死亡率为13.82%。多变量逻辑回归显示，低手术量和中等手术量中心的住院死亡风险更高（p＜0.001）。与超大手术量中心相比，小、中、大手术量项目的任何术后并发症发生率较低（p＜0.001）。低手术量和中等手术量中心与发生任何并发症患者的死亡率显著更高相关（p＜0.001）。
我们的分析表明，手术量较高的中心住院死亡风险较低。尽管高手术量中心并发症风险较高，但这些中心发生并发症后的死亡率较低。
