与长期结果相关的急性A型大动脉剖析手术的最佳年病例量
Michal J Kawczynski1,2, Sander M J van Kuijk3, Jules R Olsthoorn4,5
1Department of Cardiothoracic Surgery, Maastricht University Medical Centre (MUMC+), Maastricht, The Netherlands.
概括
对急性A型大动脉剖析手术的最佳长期存活率与每年大约32例病例有关. 超过这个值的更高的外科手术量显示患者存活率的回报正在下降.
科学领域:
- 心血管外科心血管外科
- 医疗保健服务研究 医疗服务研究
- 生物统计学 生物统计学
背景情况:
- 之前的体积结果研究主要研究短期结果.
- 评估手术体积和长期存活率之间的联系需要先进的统计方法.
- 急性A型大动脉剖析手术是这项研究的关键模型.
研究的目的:
- 引入一种新的统计方法来评估程序量与事件发生时间结果之间的关系.
- 确定最佳的年度病例数量,以在急性A型大动脉剖析手术中实现卓越的长期存活率.
主要方法:
- 进行了对52项研究 (14,878名患者) 关于急性A型大动脉剖析结果的元分析.
- 重建了个别患者的数据,以计算总生存时间的危险比率.
- 应用了受限立方线模型和肘部方法来分析体积-结果关系.
主要成果:
- 该研究包括52项研究,平均随访时间为5年.
- 总体队列存活率为1年为82%,3年为79%,5年为74%,10年为60%.
- 发现了显著的非线性体积与结果关系,最佳年病例量为32例 (95% CI 31-33).
结论:
- 大约32例的最佳年度病例与急性A型大动脉剖析手术的最佳长期存活率有关.
- 增加每年超过32例的外科手术量可能不会导致长期存活率的显著改善.
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