PDF(Pubmed)
Abstract：
OBJECTIVE: Our understanding of the impact of a center\'s case volume on failure to rescue (FTR) after cardiac surgery is incomplete. We hypothesized that increasing center case volume would be associated with lower FTR.
METHODS: Patients undergoing a Society of Thoracic Surgeons index operation in a regional collaborative (2011-2021) were included. After we excluded patients with missing Society of Thoracic Surgeons Predicted Risk of Mortality scores, patients were stratified by mean annual center case volume. The lowest quartile of case volume was compared with all other patients. Logistic regression analyzed the association between center case volume and FTR, adjusting for patient demographics, race, insurance, comorbidities, procedure type, and year.
RESULTS: A total of 43,641 patients were included across 17 centers during the study period. Of these, 5315 (12.2%) developed an FTR complication, and 735 (13.8% of those who developed an FTR complication) experienced FTR. Median annual case volume was 226, with 25th and 75th percentile cutoffs of 136 and 284 cases, respectively. Increasing center-level case volume was associated with significantly greater center-level major complication rates but lower mortality and FTR rates (all P values < .01). Observed-to-expected FTR was significantly associated with case volume (P = .040). Increasing case volume was independently associated with decreasing FTR rate in the final multivariable model (odds ratio, 0.87 per quartile; confidence interval, 0.799-0.946, P = .001).
CONCLUSIONS: Increasing center case volume is significantly associated with improved FTR rates. Assessment of low-volume centers\' FTR performance represents an opportunity for quality improvement.
METHODS: Patients undergoing a Society of Thoracic Surgeons index operation in a regional collaborative (2011-2021) were included. After we excluded patients with missing Society of Thoracic Surgeons Predicted Risk of Mortality scores, patients were stratified by mean annual center case volume. The lowest quartile of case volume was compared with all other patients. Logistic regression analyzed the association between center case volume and FTR, adjusting for patient demographics, race, insurance, comorbidities, procedure type, and year.
RESULTS: A total of 43,641 patients were included across 17 centers during the study period. Of these, 5315 (12.2%) developed an FTR complication, and 735 (13.8% of those who developed an FTR complication) experienced FTR. Median annual case volume was 226, with 25th and 75th percentile cutoffs of 136 and 284 cases, respectively. Increasing center-level case volume was associated with significantly greater center-level major complication rates but lower mortality and FTR rates (all P values < .01). Observed-to-expected FTR was significantly associated with case volume (P = .040). Increasing case volume was independently associated with decreasing FTR rate in the final multivariable model (odds ratio, 0.87 per quartile; confidence interval, 0.799-0.946, P = .001).
CONCLUSIONS: Increasing center case volume is significantly associated with improved FTR rates. Assessment of low-volume centers\' FTR performance represents an opportunity for quality improvement.
摘要：
目的：我们对中心病例量对心脏手术后抢救失败（FTR）的影响的理解是不完整的。我们假设中心病例量的增加将与较低的FTR相关。
方法：纳入了在区域合作（2011-2021）中接受STS指数手术的患者。排除STS缺失患者预测死亡风险后，患者按中心年平均病例量进行分层.将病例体积的最低四分位数与所有其他患者进行比较。Logistic回归分析中心病例体积与FTR之间的关系，根据患者的人口统计进行调整，种族,保险,合并症,程序类型,和年份。
结果：在研究期间，共有43,641名患者被纳入17个中心。其中,5315（12.2%）出现了FTR并发症，735人(发生FTR并发症的人中13.8%)经历了FTR。年病例数量中位数为226，第25和第75百分位数截止为136和284例，分别。中心级别病例体积的增加与中心级别主要并发症发生率的显著增高相关。但较低的死亡率和FTR率（所有p值<0.01）。观察到预期的FTR与病例体积显着相关（p=0.040）。在最终的多变量模型中，病例体积的增加与FTR率的降低独立相关(每四分位数OR0.87，CI0.80-0.95，p=0.001)。
结论：中心病例量的增加与抢救失败率的提高显著相关。低容量中心的FTR性能评估代表了质量改进的机会。
方法：纳入了在区域合作（2011-2021）中接受STS指数手术的患者。排除STS缺失患者预测死亡风险后，患者按中心年平均病例量进行分层.将病例体积的最低四分位数与所有其他患者进行比较。Logistic回归分析中心病例体积与FTR之间的关系，根据患者的人口统计进行调整，种族,保险,合并症,程序类型,和年份。
结果：在研究期间，共有43,641名患者被纳入17个中心。其中,5315（12.2%）出现了FTR并发症，735人(发生FTR并发症的人中13.8%)经历了FTR。年病例数量中位数为226，第25和第75百分位数截止为136和284例，分别。中心级别病例体积的增加与中心级别主要并发症发生率的显著增高相关。但较低的死亡率和FTR率（所有p值<0.01）。观察到预期的FTR与病例体积显着相关（p=0.040）。在最终的多变量模型中，病例体积的增加与FTR率的降低独立相关(每四分位数OR0.87，CI0.80-0.95，p=0.001)。
结论：中心病例量的增加与抢救失败率的提高显著相关。低容量中心的FTR性能评估代表了质量改进的机会。
