Saratzis Athanasios, Nduwayo Sarah, Bath Michael F, Sidloff David, Sayers Robert D, Bown Matthew J
Department of Cardiovascular Sciences and Leicester NIHR Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK
Department of Cardiovascular Sciences and Leicester NIHR Cardiovascular Biomedical Research Unit, University of Leicester, Leicester, UK.
Interact Cardiovasc Thorac Surg. 2016 Sep;23(3):477-85. doi: 10.1093/icvts/ivw155. Epub 2016 May 24.
Previous research suggests an association between hospital volume and outcomes in high-risk surgical pathologies. The association between hospital volume and outcomes in patients with isolated descending thoracic aortic aneurysms (DTAAs) and type-B thoracic aortic dissections (TBADs) is conflicting. We aimed to investigate this in a literature review and meta-analysis. A systematic review of the literature was performed to identify studies reporting mortality and morbidity following repair (elective or emergency) of DTAA and/or TBAD using the Medline and Embase Databases (2000-2015). Hospital volume was assessed based on the number of patients treated per institution: low volume (1-5 cases per year), medium volume (6-10) and high volume (>10). The primary outcome of interest was all-cause mortality during inpatient stay and at 30 days. Eighty-four series of non-dissecting DTAA or TBAD were included in data synthesis (4219 patients; mean age: 62 years; males: 73.5%). For all patients (emergency and elective) undergoing DTAA repair, in-hospital mortality was 8% [95% confidence interval (CI): 6-8%]. Results were not superior in high-volume centres (8 vs 6 vs 11% for high-, medium- and low-volume, respectively). Sub-analyses for emergency and elective repairs showed no significant differences. For TBAD repairs, in the combined population (emergency and elective), results reached borderline significance (P = 0.0475), favouring high-volume centres (6 vs 11 vs 14%), but this association disappeared when emergency and elective repairs were analysed separately. Nine series reported outcomes at 1 year and 5 series followed DTAA and 18 TBAD treatment. No meaningful long-term comparisons were possible due to the lack of data. No significant associations were detected between hospital volume and subsequent mortality following DTAA or TBAD treatment. Data were heterogeneous and long-term results were scarcely reported. A well-designed longitudinal study of sufficient size is required to inform future strategies in this area.
先前的研究表明，在高风险外科手术疾病中，医院手术量与治疗结果之间存在关联。在孤立性降主动脉瘤（DTAA）和B型主动脉夹层（TBAD）患者中，医院手术量与治疗结果之间的关联存在争议。我们旨在通过文献综述和荟萃分析对此进行研究。利用Medline和Embase数据库（2000 - 2015年）对文献进行系统回顾，以确定报告DTAA和/或TBAD修复（择期或急诊）后死亡率和发病率的研究。根据每个机构治疗的患者数量评估医院手术量：低手术量（每年1 - 5例）、中等手术量（6 - 10例）和高手术量（>10例）。主要关注的结果是住院期间和30天时的全因死亡率。数据合成纳入了84个非夹层DTAA或TBAD系列（4219例患者；平均年龄：62岁；男性：73.5%）。对于所有接受DTAA修复的患者（急诊和择期），住院死亡率为8%[95%置信区间（CI）：6 - 8%]。高手术量中心的结果并不更优（高、中、低手术量中心分别为8%、6%和11%）。急诊和择期修复的亚组分析显示无显著差异。对于TBAD修复，在综合人群（急诊和择期）中，结果达到临界显著性（P = 0.0475），支持高手术量中心（6%、11%和14%），但当分别分析急诊和择期修复时，这种关联消失。9个系列报告了1年的结果，5个系列随访了DTAA治疗，18个系列随访了TBAD治疗。由于缺乏数据，无法进行有意义的长期比较。在DTAA或TBAD治疗后，未检测到医院手术量与后续死亡率之间的显著关联。数据具有异质性，且很少报告长期结果。需要进行一项设计良好、规模足够的纵向研究，为该领域的未来策略提供依据。
