Schäfer Michal, McFarland Carol, Amula Venugopal, Truong Dongngan, Lambert Linda M, Griffiths Eric R, Eckhauser Aaron W, Husain S Adil, Hobbs Reilly D
Division of Cardiothoracic Surgery, University of Utah Health, Salt Lake City, Utah.
Division of Pediatric Cardiology, Seattle Children's Hospital, Seattle, Washington.
Ann Thorac Surg. 2025 May;119(5):1045-1052. doi: 10.1016/j.athoracsur.2025.01.007. Epub 2025 Jan 24.
Prior investigations of the center-specific case volume on outcomes in hypoplastic left heart syndrome have conflicting results. This study utilized the National Pediatric Cardiology-Quality Improvement Collaborative registry to investigate the center volume-outcome relationship in patients after the Norwood procedure with consideration of preoperative high-risk features.
Between 2016 and 2023, centers were categorized by Norwood procedure volume into low- (≤5 cases/y), medium- (6 to 10 cases/y), and high-volume centers (>10 cases/y). We compared preoperative high-risk features between the center volume categories and assessed survival outcomes, focusing on 30-day and 1-year mortality. We further compared short-term perioperative morbidity outcomes.
We analyzed 3397 patients from 69 institutions participating in the National Pediatric Cardiology-Quality Improvement Collaborative. Twenty-nine centers were classified as a low-, 20 as medium-, and 20 as high-volume centers. There was no difference in frequency of preoperative high-risk features among the center categories in the majority of considered variables. There was no association between the volume categories and 30-day mortality. Low-volume and medium-volume were associated with higher risk of 1-year mortality. This difference remained when adjusting for the presence of high-risk features (Low: odds ratio, 1.40 [95% CI, 1.03-1.60], P = .020; Medium: odds ratio, 1.28 [95% CI, 1.05-1.86], P = .025). Postoperative comorbidities were more frequent in low- and medium-volume centers, including the need for diagnostic and interventional catheterization.
Patients undergoing Norwood procedure in low- and medium-volume centers have worse 1-year mortality. The outcome characteristics are potentiated when adjusted for high-risk features, with significantly higher survival and lower morbidity in patients treated in high-volume centers.
先前关于特定中心的病例数量对左心发育不全综合征治疗结果影响的研究结果相互矛盾。本研究利用国家儿科心脏病学质量改进协作登记系统，在考虑术前高危特征的情况下，调查诺伍德手术后患者的中心病例数量与治疗结果之间的关系。
2016年至2023年期间，根据诺伍德手术的病例数量将各中心分为低手术量中心（≤5例/年）、中等手术量中心（6至10例/年）和高手术量中心（>10例/年）。我们比较了不同中心病例数量类别之间的术前高危特征，并评估了生存结果，重点关注30天和1年死亡率。我们还比较了短期围手术期的发病情况。
我们分析了来自参与国家儿科心脏病学质量改进协作的69家机构的3397例患者。29个中心被归类为低手术量中心，20个为中等手术量中心，20个为高手术量中心。在大多数考虑的变量中，不同中心病例数量类别之间术前高危特征的频率没有差异。病例数量类别与30天死亡率之间没有关联。低手术量和中等手术量中心与1年死亡率较高相关。在调整高危特征的存在后，这种差异仍然存在（低手术量中心：比值比，1.40[95%CI，1.03 - 1.60]，P = 0.020；中等手术量中心：比值比，1.28[95%CI，1.05 - 1.86]，P = 0.025）。低手术量和中等手术量中心术后合并症更常见，包括需要进行诊断性和介入性心导管检查。
在低手术量和中等手术量中心接受诺伍德手术的患者1年死亡率更高。在调整高危特征后，结果特征更加明显，高手术量中心治疗的患者生存率显著更高，发病率更低。
