College of Medicine, University of Nebraska Medical Center, Omaha, Nebraska, USA.
Department of Surgery, University of Nebraska Medical Center, Omaha, Nebraska, USA.
J Card Surg. 2022 Oct;37(10):3290-3299. doi: 10.1111/jocs.16783. Epub 2022 Jul 21.
In complex operations surgeon volume may impact outcomes. We sought to understand if individual surgeon volume affects left ventricular assist device (LVAD) outcomes.
We reviewed primary LVAD implants at an experienced ventricular assist devices (VAD)/transplant center between 2013 and 2019. Cases were dichotomized into a high-volume group (surgeons averaging 11 or more LVAD cases per year), and a low-volume group (10 or less per year). Propensity score matching was performed. Survival to discharge, 1-year survival, and incidence of major adverse events were compared between the low- and high-volume groups. Predictors of survival were identified with multivariate analysis.
There were 315 patients who met inclusion criteria-45 in the low-volume group, 270 in the high-volume group. There was no difference in survival to hospital discharge between the low (91.9%) and high (83.3%) volume matched groups (p = .22). Survival at 1-year was also similar (85.4% vs. 80.6%, p = .55). There was no difference in the incidence of major adverse events between the groups. Predictors of mortality in the first year included: age (hazards ratio [HR]: 1.061, p < .001), prior sternotomy (HR: 1.991, p = .01), increasing international normalized ratio (HR: 4.748, p < .001), increasing AST (HR: 1.001, p < .001), increasing bilirubin (HR: 1.081, p = .01), and preoperative mechanical ventilation (HR: 2.662, p = .005). Individual surgeon volume was not an independent predictor of discharge or 1-year survival.
There was no difference in survival or adverse events between high and low volume surgeons suggesting that, in an experienced multidisciplinary setting, low-volume VAD surgeons can achieve similar outcomes to their high-volume colleagues.
在复杂的手术中，外科医生的手术量可能会影响手术结果。我们试图了解个体外科医生的手术量是否会影响左心室辅助装置（LVAD）的结果。
我们回顾了 2013 年至 2019 年期间在一个有经验的心室辅助设备（VAD）/移植中心进行的初次 LVAD 植入病例。将病例分为高容量组（每年平均 11 例或更多 LVAD 病例的外科医生）和低容量组（每年 10 例或更少）。进行倾向评分匹配。比较低容量组和高容量组之间的出院生存率、1 年生存率和主要不良事件发生率。采用多变量分析确定生存率的预测因素。
共有 315 例符合纳入标准的患者，其中低容量组 45 例，高容量组 270 例。低容量（91.9%）和高容量（83.3%）匹配组之间的出院生存率无差异（p=0.22）。1 年生存率也相似（85.4% vs. 80.6%，p=0.55）。两组之间主要不良事件的发生率无差异。第一年死亡的预测因素包括：年龄（风险比[HR]：1.061，p<0.001）、既往开胸术（HR：1.991，p=0.01）、国际标准化比值升高（HR：4.748，p<0.001）、AST 升高（HR：1.001，p<0.001）、胆红素升高（HR：1.081，p=0.01）和术前机械通气（HR：2.662，p=0.005）。外科医生个体手术量不是出院或 1 年生存率的独立预测因素。
在经验丰富的多学科环境中，低容量 VAD 外科医生可以获得与高容量同事相似的结果，高容量和低容量外科医生之间的生存率或不良事件无差异。
