Pessôa Renato Luís
Universidade do Vale do Taquari - UNIVATES, Lajeado, RS, Brasil.
J Vasc Bras. 2023 Sep 18;22:e20220164. doi: 10.1590/1677-5449.202201642. eCollection 2023.
Previous studies indicate an inverse relationship between hospital volume and mortality after carotid endarterectomy. However, data at the level of Brazil are lacking.
To assess the relationship between hospital carotid endarterectomy procedure volumes and mortality in the state of São Paulo.
Data from the São Paulo State Hospital Information System on all carotid endarterectomies performed between 2015 and 2019 were analyzed. Hospitals were categorized into clusters by annual volume of surgeries (1-10, 11-25, and ≥26). Multiple logistic regression models were used to determine whether the volume of carotid endarterectomy procedures was an independent predictor of in-hospital mortality among patients undergoing this procedure.
Crude in-hospital mortality was nearly 60 percent lower in patients who underwent carotid endarterectomy at the highest volume hospitals than among those who underwent endarterectomy at the lowest volume hospitals (unadjusted OR of survival to hospital discharge, 2.41; 95% CI, 1.11-5.23; p = 0.027). Although this lower rate represents 1.5 fewer deaths per 100 patients treated, high-volume centers are more likely than low-volume centers to perform elective procedures, thus the analysis did not retain statistical significance when adjusted for admission character (OR, 1.69; 95% CI, 0.74-3.87; p = 0.215).
In a contemporary Brazilian registry, higher volume carotid endarterectomy centers were associated with lower in-hospital mortality than lower volume centers. Further studies are needed to verify this relationship considering the presence of symptoms in patients.
先前的研究表明，颈动脉内膜切除术后医院手术量与死亡率之间存在负相关关系。然而，巴西层面的数据尚缺。
评估圣保罗州医院颈动脉内膜切除术的手术量与死亡率之间的关系。
分析了圣保罗州医院信息系统中2015年至2019年间所有颈动脉内膜切除术的数据。医院按年手术量分为几组（1 - 10例、11 - 25例和≥26例）。使用多元逻辑回归模型来确定颈动脉内膜切除术的手术量是否是接受该手术患者院内死亡的独立预测因素。
在手术量最高的医院接受颈动脉内膜切除术的患者，其粗院内死亡率比在手术量最低的医院接受内膜切除术的患者低近60%（出院生存的未调整比值比为2.41；95%置信区间为1.11 - 5.23；p = 0.027）。尽管这一较低的死亡率意味着每100例接受治疗的患者死亡人数减少1.5例，但高手术量中心比低手术量中心更有可能进行择期手术，因此在根据入院特征进行调整后，该分析未保留统计学意义（比值比为1.69；95%置信区间为0.74 - 3.87；p = 0.215）。
在当代巴西的登记数据中，颈动脉内膜切除术手术量较高的中心与手术量较低的中心相比，院内死亡率较低。考虑到患者的症状情况，需要进一步研究来验证这种关系。
