Division of Cardiovascular Surgery, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania, USA.
J Card Surg. 2021 Aug;36(8):2669-2676. doi: 10.1111/jocs.15620. Epub 2021 May 12.
Surgeon procedural volume for complex cardiac procedures have become important quality metrics. The objective is to determine the association of surgeon and hospital case volume on patient outcomes after an aortic root replacement for aortic root aneurysms.
From 2009 to 2014, 4629 Medicare patients underwent an aortic root replacement for a root aneurysm. Procedures were performed by 1276 surgeons at 718 hospitals. Patients with endocarditis, aortic rupture, or Type-A dissection were excluded. Procedural volume was defined as mean number of cases performed each year during the study period. The impact of hospital and surgeon volume on adjusted 30-day mortality was analyzed as a continuous variable using adjusted logistic regression with cubic splines.
After an aortic root replacement, we observed a nonlinear reduction in the adjusted odds ratio for 30-day mortality as surgeon and hospital volume increased. Surgeons that performed approximately five cases/year and hospitals that completed approximately five cases/year had the greatest reduction in the odds of perioperative death. Patients treated at high-volume hospitals (≥4.5 cases/year) had a lower risk for 30-day postoperative stroke (hazard ratio [HR] = 0.51, p = .008), myocardial infarction (HR = 0.49, p = .016), hemodialysis (HR = 0.44, p = .005), and reoperation (HR = 0.48, p = .003). Additionally, patients treated with high-volume surgeons (≥9 cases/year) had lower risk for stroke (HR = 0.65, p = .005), hemodialysis (HR = 0.65, p = .03), sepsis (HR = 0.62, p = .03), and reoperation (HR = 0.67, p = .004).
Among Medicare patients undergoing an aortic root replacement, there is a strong inverse relationship between annualized surgeon and hospital case volume and postoperative outcomes. Procedural volume is an important quality metric for this high-risk procedure.
外科医生进行复杂心脏手术的手术量已成为重要的质量指标。本研究旨在确定主动脉根部置换术治疗主动脉根部瘤患者的外科医生和医院手术量与患者预后的关系。
2009 年至 2014 年，4629 名 Medicare 患者因主动脉根部瘤行主动脉根部置换术。手术由 1276 名外科医生在 718 家医院进行。排除患有心内膜炎、主动脉破裂或 A 型夹层的患者。手术量定义为研究期间每年进行的平均手术例数。使用调整后的 logistic 回归和三次样条分析，将医院和外科医生手术量对调整后 30 天死亡率的影响作为连续变量进行分析。
主动脉根部置换术后，我们观察到外科医生和医院手术量增加时，30 天死亡率的调整比值比呈非线性降低。每年进行约 5 例手术的外科医生和每年完成约 5 例手术的医院，其围手术期死亡的风险降低幅度最大。在高容量医院（≥4.5 例/年）接受治疗的患者，术后 30 天发生卒中（风险比[HR] = 0.51，p = .008）、心肌梗死（HR = 0.49，p = .016）、血液透析（HR = 0.44，p = .005）和再次手术（HR = 0.48，p = .003）的风险较低。此外，接受高容量外科医生（≥9 例/年）治疗的患者发生卒中（HR = 0.65，p = .005）、血液透析（HR = 0.65，p = .03）、脓毒症（HR = 0.62，p = .03）和再次手术（HR = 0.67，p = .004）的风险较低。
在接受主动脉根部置换术的 Medicare 患者中，外科医生和医院每年的手术量与术后结果呈强烈的负相关关系。手术量是这种高风险手术的一个重要质量指标。
