加拿大安大略省室上性心动过速导管消融术后当日出院相关因素

IF 2.5 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

CJC Open Pub Date : 2025-05-01 DOI:10.1016/j.cjco.2025.03.001

Sheldon M. Singh MD , Jiming Fang PhD , Olivia Haldenby MSc , Dennis T. Ko MD, MSc

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引用次数: 0

摘要

背景：室上性心动过速（SVT）导管消融术后当日出院（SDD）存在差异。本研究的目的是评估SVT导管消融手术后与SDD相关的因素。方法所有安大略省居民年龄均为>；纳入了2011年4月1日至2020年5月31日期间首次接受SVT消融手术的18年患者。确定了每家医院的SDD率和安大略省的年发病率。建立了一系列逻辑回归模型，以确定临床和手术特征以及实施手术的医院对SDD发生概率的影响。计算中位优势比来估计不同医院相似患者接受SDD的几率差异。结果共纳入16044例患者(年龄55.9±16.5岁；女:45.9%)。7.8%的队列接受了经间隔导管插入术。SDD的比率从2011年的61%上升到2020年的91%。SDD的住院率从41%到95%不等。在包括医院的模型中，预测SDD的辨别能力（由c统计量测量）很高，为0.84，而在不包括医院的模型中为0.58。在调整了年龄、性别、患者合并症、心律失常诊断和手术细节后，执行手术的医院的中位优势比为3.82。结论SVT消融术后SDD的变化主要与医院因素有关。鼓励决策者探索医院层面采用这一方法的障碍。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Factors Associated with Same-Day Discharge After Catheter Ablation Procedures for Supraventricular Tachycardia in Ontario, Canada

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Factors Associated with Same-Day Discharge After Catheter Ablation Procedures for Supraventricular Tachycardia in Ontario, Canada

Background

Variation exists in the practice of same-day discharge (SDD) after supraventricular tachycardia (SVT) catheter-ablation procedures. The aim of this study was to evaluate factors associated with SDD after SVT catheter-ablation procedures.

Methods

All Ontario residents aged > 18 years undergoing a first-ever SVT ablation procedure between April 1, 2011 and May 31, 2020 were included. The rate of SDD at each hospital and the annual rate within Ontario were determined. A series of logistic regression models were created to determine the influence of clinical and procedural characteristics, and of the hospital performing the procedure, on the probability of SDD occurring. The median odds ratio was calculated to estimate the variation in the odds of similar patients receiving SDD at different hospitals.

Results

The cohort included 16,044 individuals (aged 55.9 ± 16.5 years; female: 45.9%). Transseptal catheterization was performed in 7.8% of the cohort. The rate of SDD increased from 61% in 2011 to 91% in 2020. Hospital rates of SDD ranged from 41% to 95%. The discrimination ability (measured by C-statistics) in predicting SDD was high, at 0.84, in the model that included the hospital, as opposed to 0.58 in the model that did not include the hospital. After adjusting for age, sex, patient comorbidities, the arrhythmia diagnosis, and procedural details, the median odds ratio attributed to the hospital performing the procedure was 3.82.

Conclusions

Variation in SDD after SVT ablation procedures is primarily related to hospital factors. Policymakers are encouraged to explore hospital-level barriers to adopting this approach.

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