Department of Anesthesiology and Pain Medicine, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.
Department of Information Statistics, Andong National University, Andong, Gyeongsangbuk-do, Republic of Korea.
J Cardiothorac Surg. 2022 Aug 20;17(1):190. doi: 10.1186/s13019-022-01945-0.
There are only a handful of published studies regarding the volume-outcome relationship in heart valve surgery. We evaluated the association between institutional case volume and mortality after aortic valve replacement (AVR) and mitral valve replacement (MVR).
Two separate cohorts of all adults who underwent AVR or MVR, respectively, between 2009 and 2016 were analyzed using a Korean healthcare insurance database. Hospitals performing AVRs were divided into three groups according to the average annual case volume: the low- (< 20 cases/year), medium- (20-70 cases/year), and high-volume centers (> 70 cases/year). Hospitals performing MVRs were also grouped as the low- (< 15 cases/year), medium- (15-40 cases/year), or high-volume centers (> 40 cases/year). In-hospital mortality after AVR or MVR were compared among the groups.
In total, 7875 AVR and 5084 MVR cases were analyzed. In-hospital mortality after AVR was 8.3% (192/2318), 4.0% (84/2102), and 2.6% (90/3455) in the low-, medium-, and high-volume centers, respectively. The adjusted risk was higher in the low- (OR 2.31, 95% CI 1.73-3.09) and medium-volume centers (OR 1.53, 95% CI 1.09-2.15) compared to the high-volume centers. In-hospital mortality after MVR was 9.3% (155/1663), 6.3% (94/1501), and 2.9% (56/1920) in the low-, medium-, and high-volume centers, respectively. Compared to the high-volume centers, the medium- (OR 1.97, 95% CI 1.35-2.88) and low-volume centers (OR 2.29, 95% CI 1.60-3.27) showed higher adjusted risk of in-hospital mortality.
Lower case volume is associated with increased in-hospital mortality after AVR and MVR. The results warrant a comprehensive discussion regarding regionalization/centralization of cardiac valve replacements to optimize patient outcomes.
仅有少数发表的研究涉及心脏瓣膜手术中的量效关系。我们评估了机构病例量与主动脉瓣置换术（AVR）和二尖瓣置换术（MVR）后死亡率之间的关联。
使用韩国医疗保险数据库分析了分别在 2009 年至 2016 年间接受 AVR 或 MVR 的所有成年人的两个独立队列。根据年平均病例量，行 AVR 的医院分为三组：低（<20 例/年）、中（20-70 例/年）和高（>70 例/年）量中心。行 MVR 的医院也分为低（<15 例/年）、中（15-40 例/年）或高（>40 例/年）量中心。比较各组 AVR 或 MVR 后的院内死亡率。
共分析了 7875 例 AVR 和 5084 例 MVR 病例。AVR 后的院内死亡率分别为低（192/2318）、中（84/2102）和高（90/3455）量中心的 8.3%、4.0%和 2.6%。与高量中心相比，低（OR 2.31，95%CI 1.73-3.09）和中量中心（OR 1.53，95%CI 1.09-2.15）的风险更高。MVR 后的院内死亡率分别为低（155/1663）、中（94/1501）和高（56/1920）量中心的 9.3%、6.3%和 2.9%。与高量中心相比，中量（OR 1.97，95%CI 1.35-2.88）和低量（OR 2.29，95%CI 1.60-3.27）中心的院内死亡率调整后风险更高。
AVR 和 MVR 后病例量较低与院内死亡率增加相关。结果需要就心脏瓣膜置换术的区域化/集中化进行全面讨论，以优化患者结局。
