Ahmadzadeh Y Carmen, Schmitz-Rixen Th, Böckler D, Grundmann R T
Klinik für Gefäß- und Endovascularchirurgie und des Universitären Wundzentrums, Klinikum der Goethe-Universität, Frankfurt/M, Deutschland.
Klinik für Gefäßchirurgie und Endovaskuläre Chirurgie, Universitätsklinikum Heidelberg, Heidelberg, Deutschland.
Chirurg. 2021 Sep;92(9):830-837. doi: 10.1007/s00104-020-01303-7.
The MTL30 (mortality, transfer, length of stay) was proposed as a surrogate parameter for evaluating the quality of large and potentially complication-prone visceral surgical interventions.
The aim of this study was to find out to what extent the MTL30 can be correlated with the results of the abdominal aortic aneurysm (AAA) registry of the German Institute for Vascular Health Research (DIGG) of the German Society for Vascular Surgery and Vascular Medicine (DGG) and with the case volume of the participating hospitals.
Elective endovascular abdominal aortic aneurysm repair (EVAR) was performed in 14,282 patients and open repair (OAR) in 3923 patients. Case volume of the treating hospitals, hospital mortality, length of stay and transfer to another acute care hospital were determined 30 days after the index intervention.
The hospital mortality was 1.3% for EVAR and 4.9% for OAR (p = 0.000), the MTL30 was 5.0% and 14.4%, respectively (p = 0.000). For EVAR, no relationship between case volume and hospital mortality (quintile 1: 1.0%; quintile 5: 1.3%) as well as case volume and MTL30 (quintile 1: 5.3%; quintile 5: 5.3%) could be demonstrated. Also in OAR there was no significant relationship between case volume and hospital mortality (quintile 1: 5.8%, quintile 5: 3.5%; p = 0.505) and case volume and MTL30 (quintile 1: 16.4%, quintile 5: 12.2%, p = 0.110). With a hospital mortality rate of 7.2% (5-10%) the MTL30 for OAR was 17.6%. In both EVAR and OAR, the length of stay correlated significantly with hospital mortality and MTL30.
A clear relationship between hospital case volume and hospital mortality could not be shown in the AAA registry of the DIGG. The same was true for the MTL30. It remains to be seen whether the MTL30 offers an additional benefit compared to the recording of hospital mortality and inpatient length of stay as a quality parameter.
MTL30（死亡率、转院率、住院时长）被提议作为评估大型且可能容易出现并发症的内脏外科手术质量的替代参数。
本研究旨在查明MTL30在多大程度上能够与德国血管外科学会和血管医学学会（DGG）的德国血管健康研究机构（DIGG）的腹主动脉瘤（AAA）登记结果以及参与医院的病例数量相关联。
对14282例患者进行了择期血管腔内腹主动脉瘤修复术（EVAR），对3923例患者进行了开放修复术（OAR）。在索引干预30天后确定治疗医院的病例数量、医院死亡率、住院时长以及转至另一家急性护理医院的情况。
EVAR的医院死亡率为1.3%，OAR为4.9%（p = 0.000），MTL30分别为5.0%和14.4%（p = 0.000）。对于EVAR，未显示病例数量与医院死亡率（第1五分位数：1.0%；第5五分位数：1.3%）以及病例数量与MTL30（第1五分位数：5.3%；第5五分位数：5.3%）之间存在关联。在OAR中，病例数量与医院死亡率（第1五分位数：5.8%，第5五分位数：3.5%；p = 0.505）以及病例数量与MTL30（第1五分位数：16.4%，第5五分位数：12.2%，p = 0.110）之间也无显著关联。OAR的MTL30为17.6%，医院死亡率为7.2%（5 - 10%）。在EVAR和OAR中，住院时长均与医院死亡率和MTL30显著相关。
在DIGG的AAA登记中未显示医院病例数量与医院死亡率之间存在明确关联。MTL30的情况亦是如此。MTL30作为质量参数与记录医院死亡率和住院患者住院时长相比是否具有额外优势仍有待观察。
