The volume-outcome relation for pulmonary endarterectomy in chronic thrombo-embolic pulmonary hypertension.

IF 16.6 1区 医学 Q1 RESPIRATORY SYSTEM
Samuel Heuts, Michal J Kawczynski, Arthur Leus, Laurent Godinas, Catharina Belge, Vanessa van Empel, Bart Meyns, Jos G Maessen, Marion Delcroix, Tom Verbelen
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引用次数: 0

Abstract

Background: We conducted a volume-outcome (V-O) meta-analysis of PEA procedures for chronic thromboembolic pulmonary hypertension (CTEPH), to objectively determine the minimum required annual case load that can define a high-volume centre.

Methods: Three electronic databases were systematically queried until May 1st, 2024. Centres were divided in volume tertiles (Ts). The primary outcomes were early mortality and long-term survival. Restricted cubic splines were used to demonstrate the V-O relation, and the elbow-method was applied to define high-volume centres. Long-term survival was assessed using Cox-frailty models.

Results: Fifty-one centres (52 consecutive cohorts) were included and divided in tertiles (T1: <6 cases/year, T2: 6-15 cases/year, T3: >15 cases/year), comprising a total of 11 345 patients (mean age 52.3 years). Overall early mortality was 6.0% (T1: 11.6%, T2: 7.2%, T3: 5.2%, p<0.001), for which a significant non-linear volume-outcome relation was observed (p=0.0437) with a statistically determined minimally required volume of 33 cases/year (95% confidence interval [CI] 29-35 cases), and a modelled volume of 40 cases/year corresponding to a 5.0% mortality rate. Nevertheless, early mortality still progressively declined in higher volume centres (from 6.7% to 5.4% to 2.9% in centres performing 16-50, 51-100, and >100 procedures annually). In addition, a significant effect of volume was observed for long-term survival (adjusted hazard ratio per tertile 0.75, 95%CI 0.63-0.89, p=0.001).

Conclusion: There is a significant association between procedural volume and early mortality in PEA. An annual procedural volume of >33-40 cases/year may define a high-volume centre, although higher volumes still lead to progressively lower mortality rates.

慢性血栓栓塞性肺动脉高压肺动脉内膜切除术的容积-结果关系。
背景:我们对慢性血栓栓塞性肺动脉高压(CTEPH)的PEA手术进行了 "量-结果(V-O)"荟萃分析,以客观地确定界定高容量中心所需的最低年病例量:方法:系统查询了三个电子数据库,截止日期为 2024 年 5 月 1 日。中心按病例量三等分(Ts)划分。主要结果是早期死亡率和长期存活率。限制性三次样条被用来证明V-O关系,肘法被用来定义高容量中心。长期存活率采用Cox-frailty模型进行评估:结果:共纳入了 51 个中心(52 个连续队列),并将其分为三等分(T1:15 例/年),共有 11 345 名患者(平均年龄 52.3 岁)。总体早期死亡率为 6.0%(T1:11.6%,T2:7.2%,T3:5.2%,每年 100 例)。此外,观察到手术量对长期存活率有显著影响(调整后每三等分危险比为 0.75,95%CI 为 0.63-0.89,P=0.001):结论:PEA手术量与早期死亡率之间存在明显关联。年手术量>33-40例/年可定义为高手术量中心,尽管手术量越高,死亡率越低。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
European Respiratory Journal
European Respiratory Journal 医学-呼吸系统
CiteScore
27.50
自引率
3.30%
发文量
345
审稿时长
2-4 weeks
期刊介绍: The European Respiratory Journal (ERJ) is the flagship journal of the European Respiratory Society. It has a current impact factor of 24.9. The journal covers various aspects of adult and paediatric respiratory medicine, including cell biology, epidemiology, immunology, oncology, pathophysiology, imaging, occupational medicine, intensive care, sleep medicine, and thoracic surgery. In addition to original research material, the ERJ publishes editorial commentaries, reviews, short research letters, and correspondence to the editor. The articles are published continuously and collected into 12 monthly issues in two volumes per year.
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