病例数量与左心室辅助器件植入结果之间的关联 - - EUROMACS分析
Maks Mihalj1,2, David Reineke1, Isabell A Just3,4
1Department of Cardiac Surgery, University Hospital Bern, University of Bern, Bern, Switzerland.
European journal of heart failure
|August 29, 2024
概括
中心体积对左心室辅助器件 (LVAD) 患者的1年生存期没有影响. 然而,较高的病例负载与更多的不良事件有关,这表明需要在所有中心提高质量.
科学领域:
- 心脏病学 心脏病学
- 医疗器械技术 医疗器械技术
- 医疗保健服务研究 医疗服务研究
背景情况:
- 左心室辅助装置 (LVAD) 植入是晚期心力衰竭的关键治疗方法.
- 手术中心体积对患者结果的影响是质量评估的一个关键领域.
- 了解病例数量和LVAD结果之间的关系对于优化患者护理至关重要.
研究的目的:
- 为了研究医疗中心的年度病例和在接受LVAD植入的患者的术后结果之间的关联.
- 分析中心体积与生存率,不良事件和LVAD手术后再入院之间的相关性.
主要方法:
- 在2011年至2020年间,在35个中心对4802名接受LVAD植入的患者进行了回顾性分析.
- 患者被分为低 (≤30/年) 和高 (>30/年) 年度病例负载组.
- 主要终点是1年生存率;次要结果包括整体生存率,不良事件和再入院.
主要成果:
- 在高体积中心和低体积中心之间没有观察到调整后1年生存率的显著差异.
- 较高体积的中心显示了统计学上显著的较低调整整体生存概率 (p=0.002).
- 在对HeartMate 3设备的小组分析中,较高体积的中心与1年生存率的降低有关 (aOR 0.43,p=0.041).
结论:
- 中心体积与LVAD植入后的一年生存率无关,但与设备相关的不良事件有关.
- 根据中心的大小,患者的个人资料和手术前的情况发生了显著的变化.
- 持续的质量改进举措和患者选择的标准化对于所有中心来说都至关重要,以提高LVAD结果.
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