The volume-outcome relationship for pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension.

Methods

Three electronic databases were systematically queried up to 1 May 2024.

三个电子数据库系统地查询至2024年5月1日。

Centres were divided in volume tertiles.

中心按体积分为三个三分位数。

The primary outcomes were early mortality and long-term survival. Restricted cubic splines were used to demonstrate the volume-outcome relationship and the elbow-method was applied to define high-volume centres.

主要结果是早期死亡率和长期生存率。

Long-term survival was assessed using Cox frailty models.

使用Cox脆弱模型评估了长期生存情况。

Results

We included 51 centres (52 consecutive cohorts) and divided them into tertiles (T1: <6 cases per year; T2: 6-15 cases per year, T3: >15 cases per year), comprising a total 11 345 patients (mean age 52.3 years).

我们纳入了51个中心（52个连续队列），并将它们分为三个分位数（T1: 每年<6例；T2: 每年6-15例，T3: 每年>15例），共包括11,345名患者（平均年龄52.3岁）。

Overall early mortality was 6.0% (T1: 11.6%; T2: 7.2%; T3: 5.2%; p<0.001), for which a significant nonlinear volume-outcome relationship was observed (p=0.0437) with a statistically determined minimal required volume of 33 cases per year (95% CI 29-35 cases), and a modelled volume of 40 cases per year corresponding to a 5.0% mortality rate.

早期总体死亡率为6.0%（T1期：11.6%；T2期：7.2%；T3期：5.2%；p<0.001），观察到显著的非线性体积-结果关系（p=0.0437），统计确定的最小年需求量为33例（95%置信区间29-35例），模型预测的年需求量为40例，对应5.0%的死亡率。

Nevertheless, early mortality still progressively declined in higher volume centres (from 6.7% to 5.4% to 2.9% in centres performing 16-50, 51-100 and >100 procedures annually).

然而，在高容量中心，早期死亡率仍然逐渐下降（年手术量在16-50、51-100和>100例的中心，死亡率分别从6.7%下降到5.4%再到2.9%）。

In addition, a significant volume effect was observed for long-term survival (adjusted hazard ratioper tertile 0.75, 95% CI 0.63-0.89; p=0.001).

此外，对于长期生存，观察到显著的体积效应（每三分位数调整后的风险比为0.75，95%置信区间为0.63-0.89；p=0.001）。

Conclusions

There is a significant association between procedural volume and early mortality in pulmonary endarterectomy.

肺动脉内膜切除术中，程序体积与早期死亡率之间存在显著关联。

An annual procedural volume of >33-40 cases per year may be used to define a high‑volume centre, although higher volumes still lead to progressively lower mortality rates.

每年处理病例数超过33-40例可用来定义一个高容量中心，尽管更高的处理量仍会导致死亡率逐渐降低。