Williamson Catherine G, Tran Zachary, Kim Samuel T, Hadaya Joseph, Biniwale Reshma, Benharash Peyman
Cardiovascular Outcomes Research Laboratories (CORELAB), David Geffen School of Medicine at UCLA, Los Angeles, CA.
Division of Cardiac Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA.
J Pediatr. 2022 Jan;240:129-135.e2. doi: 10.1016/j.jpeds.2021.09.017. Epub 2021 Sep 20.
To characterize the relationship between surgical volume and postoperative outcomes in congenital heart surgery, we used a national cohort to assess the costs, readmissions, and complications in children undergoing cardiac operations.
The Nationwide Readmissions Database was used to identify pediatric patients (≤18 years) undergoing congenital cardiac surgery from 2010 to 2017. Hospitals were categorized based on deciles and tertiles of annual caseload with high-volume categorized as the highest tertile of volume. Multivariable regression models adjusting for patient and hospital characteristics were used to study the impact of volume on 30-day nonelective readmission, mortality, home discharge, and resource use.
Of an estimated 69 448 hospitalizations included for analysis, 56 672 (82%) occurred at high-volume centers. After adjustment for key clinical factors, each decile increase in volume was associated with a 25% relative decrease in the odds of mortality, a 14% decrease in the odds of nonhome discharge, and a 4% relative decrease in the likelihood of 30-day nonelective readmission. After risk adjustment, each incremental increase in volume decile was associated with a one-half-day decrease in the hospital length of stay, but did not alter costs of the index hospitalization. However, after including all readmissions within 30 days of the index discharge, high-volume centers were associated with significantly lower costs compared with low-volume hospitals.
Increased congenital cardiac surgery volume is associated with improved mortality, reduced duration of hospitalization, 30-day readmissions, and resource use. These findings demonstrate the inverse relationship between hospital volume and resource use and may have implications for the centralization of care for congenital cardiac surgery.
为了明确先天性心脏病手术量与术后结局之间的关系，我们使用了一个全国性队列来评估接受心脏手术儿童的费用、再入院情况及并发症。
利用全国再入院数据库识别2010年至2017年期间接受先天性心脏手术的儿科患者（≤18岁）。医院根据年度病例数的十分位数和三分位数进行分类，手术量大的医院被归类为病例数最高的三分位。采用对患者和医院特征进行调整的多变量回归模型，研究手术量对30天非选择性再入院、死亡率、出院回家以及资源利用的影响。
纳入分析的估计69448例住院病例中，56672例（82%）发生在手术量大的中心。在对关键临床因素进行调整后，手术量每增加一个十分位数，死亡率的比值相对降低25%，非出院回家的比值降低14%，30天非选择性再入院的可能性相对降低4%。在风险调整后，手术量每增加一个十分位数，住院时间缩短半天，但未改变首次住院的费用。然而，在纳入首次出院后30天内的所有再入院病例后，与手术量小的医院相比，手术量大的中心费用显著更低。
先天性心脏手术量增加与死亡率降低、住院时间缩短、30天再入院率降低以及资源利用改善相关。这些发现表明了医院手术量与资源利用之间的负相关关系，可能对先天性心脏手术的集中治疗有影响。
