Tulane University School of Medicine, Division of Trauma and Critical Care, New Orleans, LA, USA.
Louisiana State University Health-Baton Rouge, Baton Rouge, LA, USA.
Am J Surg. 2020 Sep;220(3):787-792. doi: 10.1016/j.amjsurg.2020.01.026. Epub 2020 Jan 25.
The association of procedure volume and improved outcomes has been established with infrequently performed elective operations. However, effect of trauma center volume on outcomes in emergency surgery has not been defined. We hypothesized that high volume centers (HVC) would provide better outcomes for operative major vascular injuries (MVI) than low volume centers (LVC).
The NTDB was queried from 2010 to 2014. Patients with MVI were identified and HVC were compared to LVC. HVC were defined as >480 patients per year with ISS≥15.
There were 37,125 patients with MVI, with 16,461 (44.3%) managed operatively. Of these, 15,965 (97%) underwent surgery at HVC and 496 (3%) at LVC. There was no difference in shunt utilization, however, HVC were more likely to utilize endovascular repair (31.0% vs. 21.9%, p < 0.001). Rates of death, amputation, and compartment syndrome were similar. HVC were more likely to develop pneumonia or sepsis. On logistic regression, HVC was not associated with survival (OR: 0.90, 95%CI: 0.60-1.34, p = 0.60). Variables associated with mortality for HVC and LVC included thoracic arterial injury (OR: 1.57, 95%CI: 1.27-1.94, p < 0.001), penetrating mechanism (OR:1.84, 95%CI: 1.57-2.15, p < 0.001), and open repair (OR: 1.95, 95%CI: 1.69-2.26, p < 0.001). Lower ISS (OR: 0.29, 95%CI: 0.24-0.34, p < 0.001) and higher presenting blood pressure (OR: 0.99, 95%CI: 0.99-1.00, p < 0.001) were associated with survival.
Although LVC may have less proficiency with endovascular techniques, trauma center volume does not influence survival in emergency surgery for MVI.
手术量与改善结果之间的关联已在很少进行的择期手术中得到证实。然而，创伤中心的容量对急诊手术中主要血管损伤（MVI）的结果的影响尚未确定。我们假设高容量中心（HVC）为 MVI 的手术治疗提供了比低容量中心（LVC）更好的结果。
从 2010 年到 2014 年，我们查询了 NTDB。确定了 MVI 患者，并将 HVC 与 LVC 进行了比较。HVC 定义为每年>480 例，ISS≥15。
共有 37125 例 MVI 患者，其中 16461 例（44.3%）接受手术治疗。其中，15965 例（97%）在 HVC 进行手术，496 例（3%）在 LVC 进行手术。分流术的使用率没有差异，但是 HVC 更有可能使用血管内修复（31.0% vs. 21.9%，p<0.001）。死亡率、截肢率和间隔综合征发生率相似。HVC 更容易发生肺炎或败血症。在逻辑回归中，HVC 与生存率无关（OR：0.90，95%CI：0.60-1.34，p=0.60）。与 HVC 和 LVC 死亡率相关的变量包括胸动脉损伤（OR：1.57，95%CI：1.27-1.94，p<0.001）、穿透性机制（OR：1.84，95%CI：1.57-2.15，p<0.001）和开放性修复（OR：1.95，95%CI：1.69-2.26，p<0.001）。ISS 较低（OR：0.29，95%CI：0.24-0.34，p<0.001）和较高的初始血压（OR：0.99，95%CI：0.99-1.00，p<0.001）与生存率相关。
尽管 LVC 在血管内技术方面可能不太熟练，但创伤中心的容量并不会影响 MVI 的急诊手术的生存率。
