Hirata Yasutaka, Nemoto Shintaro, Hamada Yusei, Nakajima Akihiro, Nishiwaki Yasumi, Kikuchi Kosuke
Department of Cardiovascular Surgery, National Center for Child Health and Development, 2-10-1 Okura, Setagaya-Ku, Tokyo, 157-8535, Japan.
Department of Thoracic and Cardiovascular Surgery, Osaka Medical and Pharmaceutical University, Osaka, Japan.
Gen Thorac Cardiovasc Surg. 2025 Jun 23. doi: 10.1007/s11748-025-02174-7.
Reinterventions after congenital heart disease surgery include not only reoperations but also medical catheter interventions, and the details of these treatment realities are often unclear. This study aimed to elucidate the medical and surgical reinterventions and associated medical costs after the tetralogy of Fallot (TOF) repair using Japanese health insurance claims data.
We analyzed reinterventions and medical costs from insurance claims data of patients who underwent TOF repair between 2005 and 2021. Of 174 patients who underwent TOF repair, 23 (13.2%) received a total of 34 reinterventions. These included 23 percutaneous catheter interventions and 11 reoperations. The 5-year reintervention-free rate was 87.5% overall, 94.9% for surgeries with right ventricular outflow tract reconstruction (N = 130), and 65.6% for surgeries with peripheral pulmonary artery plasty (N = 44). The median (interquartile range) medical cost for patients without reintervention was ¥5.33 million (4.62-7.14 million) and the cost for the patients with reintervention was ¥ 10.59 million (7.73-13.97 million).
Using Japanese insurance claims data, we analyzed the reoperation and catheter intervention after the TOF repair. The reintervention-free rate after TOF repair differed significantly by surgical procedure with a tendency for poorer postoperative prognosis, particularly in cases involving the peripheral pulmonary artery plasty. These analysis results may contribute to predicting outcomes after TOF repair for healthcare professionals.
先天性心脏病手术后的再次干预不仅包括再次手术，还包括医学导管介入治疗，而这些治疗实际情况的细节往往并不清楚。本研究旨在利用日本医疗保险理赔数据阐明法洛四联症（TOF）修复术后的医学和外科再次干预及相关医疗费用。
我们分析了2005年至2021年间接受TOF修复术患者的保险理赔数据中的再次干预情况和医疗费用。在174例接受TOF修复术的患者中，23例（13.2%）共接受了34次再次干预。其中包括23次经皮导管介入治疗和11次再次手术。总体5年无再次干预率为87.5%，右心室流出道重建手术（N = 130）为94.9%，外周肺动脉成形术手术（N = 44）为65.6%。无再次干预患者的医疗费用中位数（四分位间距）为533万日元（462 - 714万日元），有再次干预患者的费用为1059万日元（773 - 1397万日元）。
利用日本保险理赔数据，我们分析了TOF修复术后的再次手术和导管介入治疗。TOF修复术后的无再次干预率因手术方式不同而有显著差异，术后预后较差的趋势明显，尤其是在外周肺动脉成形术的病例中。这些分析结果可能有助于医疗专业人员预测TOF修复术后的结果。
