当前位置： SCI文献检索 > JOURNAL OF VASCULAR SURGERY期刊下所有文献 > Surgical treatment of intact thoracoabdominal aortic aneurysms in the United States: hospital and surgeon volume-related outcomes.

Surgical treatment of intact thoracoabdominal aortic aneurysms in the United States: hospital and surgeon volume-related outcomes.

Abstract：

OBJECTIVE:Surgical treatment of intact thoracoabdominal aortic aneurysm (TAAA) is crucial to prevent rupture but is associated with high perioperative mortality. We tested the hypothesis that provider volume of surgical treatment of TAAA is an important determinant of operative outcome. Patients and methods Clinical information regarding repair of intact TAAA in 1542 patients from 1988 to 1998 was obtained from the Nationwide Inpatient Sample (NIS), a stratified discharge database of a representative 20% of US hospitals. Demographic data included age, sex, race, nature of admission, and comorbid conditions. Annual hospital volume of TAAA treated was grouped into terciles and defined as low (LVH; 1-3 cases [median, 1]), medium (MVH; 2-9 cases [median, 4]), or high (HVH; 5-31 cases [median, 12]). Annual surgeon volume was defined as low (LVS; 1-2 cases [median, 1]) or high (HVS; 3-18 cases [median, 7]). The primary outcome measure was in-hospital postoperative mortality. Secondary outcome measures included length of stay, and cardiac, pulmonary, and renal complications. Adjusted and unadjusted analyses were conducted. RESULTS:Overall mortality was 22.3%. Mortality improved over time. LVH and HVH differed in mortality rates (27.4% vs 15.0%; P <.001). Mortality between LVS and HVS also differed significantly (25.6% vs 11.0%; P <.001). When controlling for patient demographic data, comorbid conditions, and postoperative complications, both hospital and surgeon volume were significant predictors of mortality for intact TAAA repair (LVS: odds ratio [OR] 2.6, P <.001; LVH: OR 2.2, P <.001; and MVH: OR 1.7, P =.004). CONCLUSIONS:Greater hospital and surgeon TAAA treatment volumes contribute to better outcome. Given the relative high perioperative mortality associated with TAAA repair, regionalization of care to high-volume providers with consistently lower postoperative mortality deserves consideration by patients, physicians, and health care planners.

journal_name

J Vasc Surg

journal_title

Journal of vascular surgery

authors

Cowan JA Jr,Dimick JB,Henke PK,Huber TS,Stanley JC,Upchurch GR Jr

doi

10.1016/s0741-5214(03)00085-5

subject

Has Abstract

pub_date

2003-06-01 00:00:00

pages

1169-74

issue

eissn

0741-5214

issn

1097-6809

pii

S0741521403000855

journal_volume

pub_type

杂志文章

在线工具

Surgical treatment of intact thoracoabdominal aortic aneurysms in the United States: hospital and surgeon volume-related outcomes.