Divisions of Vascular Surgery, University of Rochester Medical Center, Rochester, NY; Surgical Health Outcomes Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, NY.
Surgical Health Outcomes Research Enterprise (SHORE), University of Rochester Medical Center, Rochester, NY.
J Vasc Surg. 2019 Sep;70(3):762-767. doi: 10.1016/j.jvs.2018.11.027. Epub 2019 Mar 7.
The annual number of open abdominal aortic aneurysm (AAA) repairs has decreased dramatically over the last decade, making the search for physician case volume thresholds more important. The purpose of this study was to identify a minimum threshold for annual surgeon case volume in open AAA repair.
The New York Statewide Planning and Research Cooperative System inpatient database was used to identify all patients undergoing open repair of an intact AAA between 2000 and 2008. Thirty-day survival was calculated using New York State vital records, which contain all New York State death certificates. The annual case volume for each surgeon was defined as the number of open AAA repairs performed in the year of the index procedure. The Contal and O'Quigley method was used to identify a minimum volume threshold.
A total of 11,086 patients were included in the analysis. The selected cutpoint was six or more cases per year based on maximization of the Contal and O'Quigley test statistic. The high-volume group had comparable rates of cardiovascular comorbidities, but significantly improved 30-day and 5-year survival rates as well as shorter lengths of stay in the hospital.
This study identifies an ideal threshold for minimum annual surgeon case volume for open AAA repair. Over the study period, perioperative mortality would not have occurred in up to 150 patients if all procedures had been done by high-volume surgeons performing at least six repairs per year. However, even a minimum annual threshold of at least two repairs per year provided a mortality benefit. Ideal minimum volume thresholds should be developed using rigorous statistical analysis as well as local information about practice patterns.
在过去十年中，开放性腹主动脉瘤（AAA）修复的年手术量急剧下降，因此寻找医生手术量的阈值变得更加重要。本研究的目的是确定开放性 AAA 修复术的外科医生年度手术量的最低阈值。
利用纽约州全州规划和研究合作系统住院患者数据库，确定 2000 年至 2008 年间所有接受开放性 AAA 修复的患者。使用纽约州生命记录（包含所有纽约州的死亡证明）计算 30 天生存率。每位外科医生的年度手术量定义为索引手术当年进行的开放性 AAA 修复数量。使用 Contal 和 O'Quigley 方法确定最小的容量阈值。
共有 11086 例患者纳入分析。基于 Contal 和 O'Quigley 检验统计量的最大化，选择的切点为每年 6 例或以上。高容量组心血管合并症的发生率相似，但 30 天和 5 年生存率显著提高，住院时间也明显缩短。
本研究确定了开放性 AAA 修复术外科医生年度手术量的理想阈值。在研究期间，如果所有手术均由每年至少完成 6 例手术的高容量外科医生进行，多达 150 名患者的围手术期死亡率本可以避免。但是，即使每年进行至少 2 例手术的最低年度阈值也可以降低死亡率。理想的最小容量阈值应使用严格的统计分析以及有关实践模式的本地信息来确定。
