Facultad de Medicina, Instituto de Investigaciones Clínicas, Universidad Nacional de Colombia, Bogotá, Colombia.
Hospital Universitario Nacional de Colombia, Bogotá, Colombia.
PLoS One. 2023 Aug 25;18(8):e0290734. doi: 10.1371/journal.pone.0290734. eCollection 2023.
The effect of teaching hospital status on cardiovascular surgery has been of common interest in recent decades, yet its magnitude on heart valve replacement is still a matter of debate. Given the ethical and practical unfeasibility of randomly assigning a patient to such an exposure, we use the inverse probability of treatment weighting (IPTW) to assess this marginal effect on the survival of Colombian patients who underwent a first heart valve replacement between 2016 and 2019.
A retrospective cohort study was conducted based on administrative records. The time-to-death event and cumulative incidences of death, readmission, and reoperation are presented as outcomes. An artificial sample is configured through IPTW, adjusting for sociodemographic variables, comorbidities, technique, and intervention weight.
Of a sample of 3,517 patients, 1,051 (29.9%) were operated on in a teaching hospital. The median age was 65.0 (18.1-91.5), 38.5% of patients were ≤60, and 6.9% were ≥80. The cumulative incidences of death at 30, 90 days, and one year were 5.9%, 8%, and 10.9%, respectively. Furthermore, 23.5% of the patients were readmitted within 90 days and 3.6% underwent reintervention within one year. The odds of 30-day mortality are lower for patients operated in a teaching hospital (OR 0.51; 95% CI 0.29-0.92); however, no effect on survival was identified in terms of time-to-event of death (HR 1.07; 95%CI 0.78-1.46).
After IPTW, the odds of 30-day mortality are lower for patients operated in a teaching hospital. There was no effect on survival, 90-day or one-year mortality, 90-day readmission, or one-year reintervention. Together, we offer an opening for investigating an exposure that has yet to be explored in Latin America with potential value to understand teaching hospitals as the essential nature of reality of an academic-clinical synergy.
教学医院的地位对心血管外科学的影响一直是近几十年来的共同关注点，但它对心脏瓣膜置换术的影响仍存在争议。鉴于将患者随机分配到这种暴露状态在伦理和实践上是不可行的，我们使用逆概率治疗加权（IPTW）来评估哥伦比亚 2016 年至 2019 年间首次接受心脏瓣膜置换术的患者的生存情况。
本研究基于行政记录进行回顾性队列研究。将死亡时间事件和死亡率、再入院率和再次手术率的累积发生率作为结果呈现。通过 IPTW 配置人工样本，调整社会人口统计学变量、合并症、技术和干预权重。
在 3517 名患者的样本中，有 1051 名（29.9%）在教学医院接受手术。中位年龄为 65.0（18.1-91.5）岁，38.5%的患者年龄≤60 岁，6.9%的患者年龄≥80 岁。30 天、90 天和 1 年的死亡率累积发生率分别为 5.9%、8%和 10.9%。此外，23.5%的患者在 90 天内再次入院，3.6%的患者在 1 年内再次手术。在教学医院接受手术的患者 30 天死亡率的可能性较低（OR 0.51；95%CI 0.29-0.92）；然而，在死亡时间的生存方面没有发现影响（HR 1.07；95%CI 0.78-1.46）。
在进行 IPTW 后，在教学医院接受手术的患者 30 天死亡率的可能性较低。在 90 天或 1 年死亡率、90 天再入院率和 1 年再次手术率方面没有影响。综上所述，我们为在拉丁美洲尚未探索过的暴露因素提供了一个切入点，这可能有助于了解教学医院作为学术-临床协同作用的本质现实。
