胰腺移植中的中心容量-结局效应：一项全国性分析。

The center volume-outcome effect in pancreas transplantation: a national analysis.

作者信息

Kim Young, Dhar Vikrom K, Wima Koffi, Jung Andrew D, Xia Brent T, Hoehn Richard S, Diwan Tayyab S, Shah Shimul A

机构信息

Division of Transplantation, Department of Surgery, University of Cincinnati College of Medicine, Cincinnati Research in Outcomes and Safety in Surgery (CROSS), Cincinnati, Ohio.

出版信息

J Surg Res. 2017 Jun 1;213:25-31. doi: 10.1016/j.jss.2017.02.025. Epub 2017 Feb 24.

DOI:10.1016/j.jss.2017.02.025

PMID:28601322

Abstract

BACKGROUND

Although increased hospital volume has been correlated with improved outcomes in certain surgical procedures, the effect of center volume on pancreas transplantation (PT) is less understood. Our study aims to establish whether a volume-outcome effect exists for PT.

METHODS

Through an established linkage between the University HealthSystem Consortium and the Scientific Registry of Transplant Recipients (SRTR) databases, we performed a retrospective cohort analysis of adult PT recipients between 2009 and 2012. Surgical volume was divided equally into low volume (LV), middle volume (MV), and high volume (HV) tertiles for each year that was studied. Hospital outcomes were measured through University HealthSystem Consortium, and long-term outcomes were measured through Scientific Registry of Transplant Recipients. Statistical analysis was performed using regression analyses and the Kaplan-Meier method. Median follow-up period was 2 y.

RESULTS

Among the 2309 PT recipients included, 815 (35.3%) were performed at LV centers, 755 (32.7%) at MV centers, and 739 (32.0%) at HV centers. Compared with MV and LV centers, organs transplanted at HV centers were more frequently donation after cardiac death (5.1% versus 2.4% versus 3.3%, P = 0.01) and from older donors (2.8% [>50 y] versus 0.8% versus 0.1%, P < 0.001). In addition, HV recipients were older (31.5% [>50 y] versus 20.9% versus 19.7%, P < 0.001) and had worse functional status (39.5% dependent versus 9.7% versus 9.9%, P < 0.001). Patient and graft survival were similar across hospital volume tertiles. Center volume was not predictive of readmission rates, total length of stay, intensive care unit length of stay, or total direct cost on multivariate analysis (all P > 0.05).

CONCLUSIONS

Short- and long-term outcomes after PT are not affected by hospital volume. Although LV centers confine their cases to low-risk patients, HV centers transplant a higher percentage of high-risk donor and recipient combinations with equivalent outcomes.

摘要

背景

尽管在某些外科手术中，医院手术量的增加与预后改善相关，但中心手术量对胰腺移植（PT）的影响尚不清楚。我们的研究旨在确定PT是否存在手术量-预后效应。

方法

通过大学卫生系统联盟与移植受者科学登记处（SRTR）数据库之间已建立的链接，我们对2009年至2012年期间的成年PT受者进行了回顾性队列分析。对于所研究的每一年，手术量被平均分为低手术量（LV）、中等手术量（MV）和高手术量（HV）三分位数。通过大学卫生系统联盟衡量医院预后，通过移植受者科学登记处衡量长期预后。使用回归分析和Kaplan-Meier方法进行统计分析。中位随访期为2年。

结果

在纳入的2309名PT受者中，815名（35.3%）在LV中心进行移植，755名（32.7%）在MV中心进行移植，739名（32.0%）在HV中心进行移植。与MV和LV中心相比，在HV中心移植的器官更常来自心脏死亡后的捐赠（5.1%对2.4%对3.3%，P = 0.01），且捐赠者年龄更大（2.8%[>50岁]对0.8%对0.1%，P < 0.001）。此外，HV受者年龄更大（31.5%[>50岁]对20.9%对19.7%，P < 0.001），功能状态更差（依赖者占39.5%对9.7%对9.9%，P < 0.001）。患者和移植物存活率在各医院手术量三分位数之间相似。在多变量分析中，中心手术量不能预测再入院率、总住院时间、重症监护病房住院时间或总直接费用（所有P > 0.05）。