Jae-Woo Ju,Jaeyeon Chung,Gang Heo,Youn Joung Cho,Yunseok Jeon,Karam Nam
{"title":"围手术期使用肺动脉导管对心脏手术临床结果的影响:全国队列研究","authors":"Jae-Woo Ju,Jaeyeon Chung,Gang Heo,Youn Joung Cho,Yunseok Jeon,Karam Nam","doi":"10.1016/j.chest.2024.10.008","DOIUrl":null,"url":null,"abstract":"BACKGROUND\r\nEvidence on the effectiveness of pulmonary artery catheters (PACs) in cardiac surgery is scarce.\r\n\r\nRESEARCH QUESTION\r\nDoes perioperative PAC use decrease on 1-year all-cause mortality in patients undergoing cardiac surgery?\r\n\r\nSTUDY DESIGN AND METHODS\r\nThis nationwide, population-based cohort study included all adult patients who underwent cardiac surgery in Korea between January 2011 and December 2020 using a Korean health insurance claim database. We compared the primary outcome, the risk of 1-year all-cause mortality, between patients with and without perioperative use of PACs (PAC and no-PAC groups, respectively) using logistic regression analysis after stabilized inverse probability of treatment weighting. A subgroup analysis was performed to determine whether the association varied according to the type of cardiac surgery and institutional case volume.\r\n\r\nRESULTS\r\nA total of 61,405 patients were analyzed. The PAC group had a significantly lower risk of 1-year all-cause mortality than that in the no-PAC group (adjusted odds ratio [OR], 0.81; 95% confidence interval [CI], 0.76-0.86). In the subgroup analysis, both the type of cardiac surgery and institutional case volume were identified as significant modifiers (all P for interaction<0.001). Specifically, the PAC group had a significantly lower risk of 1-year all-cause mortality following isolated off-pump coronary artery bypass grafting (adjusted OR, 0.54; 95% CI, 0.48-0.61) compared to the no-PAC group. PAC use was associated with a significant reduction in the risk of 1-year all-cause mortality in the lowest-case volume centers (<100 cases/year; OR, 0.70; 95% CI, 0.65-0.76).\r\n\r\nINTERPRETATION\r\nPerioperative use of PACs was associated with a significant reduction in the risk of postoperative 1-year all-cause mortality. This association was predominantly driven by patients who underwent off-pump coronary artery bypass grafting and those who underwent cardiac surgery in less experienced centers.","PeriodicalId":9782,"journal":{"name":"Chest","volume":null,"pages":null},"PeriodicalIF":9.5000,"publicationDate":"2024-10-17","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impact of Perioperative Pulmonary Artery Catheter Use on Clinical Outcomes Following Cardiac Surgery: A Nationwide Cohort Study.\",\"authors\":\"Jae-Woo Ju,Jaeyeon Chung,Gang Heo,Youn Joung Cho,Yunseok Jeon,Karam Nam\",\"doi\":\"10.1016/j.chest.2024.10.008\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"BACKGROUND\\r\\nEvidence on the effectiveness of pulmonary artery catheters (PACs) in cardiac surgery is scarce.\\r\\n\\r\\nRESEARCH QUESTION\\r\\nDoes perioperative PAC use decrease on 1-year all-cause mortality in patients undergoing cardiac surgery?\\r\\n\\r\\nSTUDY DESIGN AND METHODS\\r\\nThis nationwide, population-based cohort study included all adult patients who underwent cardiac surgery in Korea between January 2011 and December 2020 using a Korean health insurance claim database. We compared the primary outcome, the risk of 1-year all-cause mortality, between patients with and without perioperative use of PACs (PAC and no-PAC groups, respectively) using logistic regression analysis after stabilized inverse probability of treatment weighting. A subgroup analysis was performed to determine whether the association varied according to the type of cardiac surgery and institutional case volume.\\r\\n\\r\\nRESULTS\\r\\nA total of 61,405 patients were analyzed. The PAC group had a significantly lower risk of 1-year all-cause mortality than that in the no-PAC group (adjusted odds ratio [OR], 0.81; 95% confidence interval [CI], 0.76-0.86). In the subgroup analysis, both the type of cardiac surgery and institutional case volume were identified as significant modifiers (all P for interaction<0.001). Specifically, the PAC group had a significantly lower risk of 1-year all-cause mortality following isolated off-pump coronary artery bypass grafting (adjusted OR, 0.54; 95% CI, 0.48-0.61) compared to the no-PAC group. PAC use was associated with a significant reduction in the risk of 1-year all-cause mortality in the lowest-case volume centers (<100 cases/year; OR, 0.70; 95% CI, 0.65-0.76).\\r\\n\\r\\nINTERPRETATION\\r\\nPerioperative use of PACs was associated with a significant reduction in the risk of postoperative 1-year all-cause mortality. This association was predominantly driven by patients who underwent off-pump coronary artery bypass grafting and those who underwent cardiac surgery in less experienced centers.\",\"PeriodicalId\":9782,\"journal\":{\"name\":\"Chest\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":9.5000,\"publicationDate\":\"2024-10-17\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Chest\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1016/j.chest.2024.10.008\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"Q1\",\"JCRName\":\"CRITICAL CARE MEDICINE\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Chest","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1016/j.chest.2024.10.008","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q1","JCRName":"CRITICAL CARE MEDICINE","Score":null,"Total":0}
Impact of Perioperative Pulmonary Artery Catheter Use on Clinical Outcomes Following Cardiac Surgery: A Nationwide Cohort Study.
BACKGROUND
Evidence on the effectiveness of pulmonary artery catheters (PACs) in cardiac surgery is scarce.
RESEARCH QUESTION
Does perioperative PAC use decrease on 1-year all-cause mortality in patients undergoing cardiac surgery?
STUDY DESIGN AND METHODS
This nationwide, population-based cohort study included all adult patients who underwent cardiac surgery in Korea between January 2011 and December 2020 using a Korean health insurance claim database. We compared the primary outcome, the risk of 1-year all-cause mortality, between patients with and without perioperative use of PACs (PAC and no-PAC groups, respectively) using logistic regression analysis after stabilized inverse probability of treatment weighting. A subgroup analysis was performed to determine whether the association varied according to the type of cardiac surgery and institutional case volume.
RESULTS
A total of 61,405 patients were analyzed. The PAC group had a significantly lower risk of 1-year all-cause mortality than that in the no-PAC group (adjusted odds ratio [OR], 0.81; 95% confidence interval [CI], 0.76-0.86). In the subgroup analysis, both the type of cardiac surgery and institutional case volume were identified as significant modifiers (all P for interaction<0.001). Specifically, the PAC group had a significantly lower risk of 1-year all-cause mortality following isolated off-pump coronary artery bypass grafting (adjusted OR, 0.54; 95% CI, 0.48-0.61) compared to the no-PAC group. PAC use was associated with a significant reduction in the risk of 1-year all-cause mortality in the lowest-case volume centers (<100 cases/year; OR, 0.70; 95% CI, 0.65-0.76).
INTERPRETATION
Perioperative use of PACs was associated with a significant reduction in the risk of postoperative 1-year all-cause mortality. This association was predominantly driven by patients who underwent off-pump coronary artery bypass grafting and those who underwent cardiac surgery in less experienced centers.
期刊介绍:
At CHEST, our mission is to revolutionize patient care through the collaboration of multidisciplinary clinicians in the fields of pulmonary, critical care, and sleep medicine. We achieve this by publishing cutting-edge clinical research that addresses current challenges and brings forth future advancements. To enhance understanding in a rapidly evolving field, CHEST also features review articles, commentaries, and facilitates discussions on emerging controversies. We place great emphasis on scientific rigor, employing a rigorous peer review process, and ensuring all accepted content is published online within two weeks.