根据医疗服务提供者的专业领域和手术量来看颈动脉支架置入术的临床结果。
Clinical Outcome of Carotid Artery Stenting According to Provider Specialty and Volume.
作者信息
AbuRahma Ali F, Campbell John E, Hariri Nizar, AbuRahma Joseph, Dean L Scott, Bates Mark C, Nanjundappa Aravinda, Stone Patrick A, O'vil Ace
机构信息
Charleston Area Medical Center Vascular Center of Excellence, Charleston, WV; Department of Surgery, West Virginia University, Charleston, WV.
Department of Surgery, West Virginia University, Charleston, WV.
出版信息
Ann Vasc Surg. 2017 Oct;44:361-367. doi: 10.1016/j.avsg.2017.04.028. Epub 2017 May 8.
BACKGROUND
Several studies have demonstrated better outcomes for carotid endarterectomy with high-volume hospitals and providers. However, only a few studies have reported on the impact of operator specialty/volume on the perioperative outcome of carotid artery stenting (CAS). This study will analyze the correlation of CAS outcomes and provider specialty and volume.
METHODS
Prospectively collected data of CAS procedures done at our institution during a 10-year period were analyzed. Major adverse events (MAEs; 30-day stroke, myocardial infarction, and death) were compared according to provider specialty (vascular surgeons [VSs], interventional cardiologists [ICs], interventional radiologists [IRs], interventional vascular medicine [IVM]), and volume (≥5 CAS/year vs. <5 CAS/year).
RESULTS
Four hundred fourteen CAS procedures (44% for symptomatic indications) were analyzed. Demographics/clinical characteristics were somewhat similar between specialties. MAE rates were not significantly different between various specialties: 3.1% for IC, 6.3% for VS, 7.1% for IR, 6.7% for IVM (P = 0.3121; 6.3% for VS and 3.8% for others combined, P = 0.2469). When physicians with <5 CAS/year were excluded: the MAE rates were 3.1% for IC, 4.7% for VS, and 6.7% for IVM (P = 0.5633). When VS alone were compared with others, and physicians with <5 CAS/year were excluded, the MAE rates were 4.7% for VS vs. 3.6% for non-VS (P = 0.5958). The MAE rates for low-volume providers, regardless of their specialty, were 9.5% vs. 4% for high-volume providers (P = 0.1002). Logistic regression analysis showed that the odds ratio of MAE was 0.4 (0.15-1.1, P = 0.0674) for high-volume providers, while the odds ratio for VS was 1.3 (0.45-3.954, P = 0.5969).
CONCLUSIONS
Perioperative MAE rates for CAS were similar between various providers, regardless of specialties, particularly for vascular surgeons with similar volume to nonvascular surgeons. Low-volume providers had higher MAE rates.
背景
多项研究表明，在高手术量的医院和医疗服务提供者处进行颈动脉内膜切除术可取得更好的效果。然而，仅有少数研究报道了手术医生的专业/手术量对颈动脉支架置入术（CAS）围手术期结果的影响。本研究将分析CAS结果与医疗服务提供者的专业及手术量之间的相关性。
方法
对我们机构在10年期间前瞻性收集的CAS手术数据进行分析。根据医疗服务提供者的专业（血管外科医生[VS]、介入心脏病学家[IC]、介入放射科医生[IR]、介入血管医学医生[IVM]）和手术量（每年≥5例CAS手术与每年<5例CAS手术）比较主要不良事件（MAE；30天内发生的卒中、心肌梗死和死亡）。
结果
分析了414例CAS手术（44%为有症状适应证）。各专业之间的人口统计学/临床特征有些相似。不同专业之间的MAE发生率无显著差异：IC为3.1%，VS为6.3%，IR为7.1%，IVM为6.7%（P = 0.3121；VS为6.3%，其他专业合并为3.8%，P = 0.2469）。排除每年进行<5例CAS手术的医生后：IC的MAE发生率为3.1%，VS为4.7%，IVM为6.7%（P = 0.5633）。当仅将VS与其他专业进行比较，且排除每年进行<5例CAS手术的医生时，VS的MAE发生率为4.7%，非VS为3.6%（P = 0.5958）。低手术量医疗服务提供者的MAE发生率为9.5%，高手术量医疗服务提供者为4%（P = 0.1002）。逻辑回归分析显示，高手术量医疗服务提供者发生MAE的比值比为0.4（0.15 - 1.1，P = 0.0674），而VS的比值比为1.3（0.45 - 3.954，P = 0.5969）。
结论
无论专业如何，各医疗服务提供者进行CAS的围手术期MAE发生率相似，特别是手术量与非血管外科医生相似的血管外科医生。低手术量医疗服务提供者的MAE发生率较高。
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