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Yoshimura N, Hirata Y, Inuzuka R, Tachimori H, Hirano A, Sakurai T, Shiraishi S, Matsui H, Ayusawa M, Nakano T, Kasahara S, Hiramatsu Y, Yamagishi M, Miyata H, Yamagishi H, Sakamoto K. Effect of procedural volume on the outcomes of congenital heart surgery in Japan. J Thorac Cardiovasc Surg 2023; 165:1541-1550.e3. [PMID: 35963799 DOI: 10.1016/j.jtcvs.2022.06.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2022] [Revised: 04/28/2022] [Accepted: 06/09/2022] [Indexed: 10/18/2022]
Abstract
OBJECTIVES The present study developed a new risk model for congenital heart surgery in Japan and determined the relationship between hospital procedural volume and mortality using the developed model. METHODS We analyzed 47,164 operations performed between 2013 and 2018 registered in the Japan Cardiovascular Surgery Database-Congenital and created a new risk model to predict the 90-day/in-hospital mortality using the Japanese congenital heart surgery mortality categories and patient characteristics. The observed/expected ratios of mortality were compared among 4 groups based on annual hospital procedural volume (group A [5539 procedures performed in 90 hospitals]: ≤50, group B [9322 procedures in 24 hospitals]: 51-100, group C [13,331 procedures in 21 hospitals]: 101-150, group D [18,972 procedures in 15 hospitals]: ≥151). RESULTS The overall mortality rate was 2.64%. The new risk model using the surgical mortality category, age-weight categories, urgency, and preoperative mechanical ventilation and inotropic use achieved a c-index of 0.81. The observed/expected ratios based on the new risk model were 1.37 (95% confidence interval, 1.18-1.58), 1.21 (1.08-1.33), 1.04 (0.94-1.14), and 0.78 (0.71-0.86) in groups A, B, C, and D, respectively. In the per-procedure analysis, the observed/expected ratios of the Rastelli, coarctation complex repair, and arterial switch procedures in group A were all more than 3.0. CONCLUSIONS The risk-adjusted mortality rate for low-volume hospitals was high for not only high-risk but also medium-risk procedures. Although the overall mortality rate for congenital heart surgeries is low in Japan, the observed volume-mortality relationship suggests potential for improvement in surgical outcomes.
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Affiliation(s)
- Naoki Yoshimura
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan.
| | - Yasutaka Hirata
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | - Ryo Inuzuka
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | - Hisateru Tachimori
- Translation Medical Center, National Center of Neurology and Psychiatry, Tokyo, Japan; Endowed Course for Health System Innovation, Keio University School of Medicine, Tokyo, Japan; Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akinori Hirano
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | - Takahisa Sakurai
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | - Shuichi Shiraishi
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | - Hikoro Matsui
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | - Mamoru Ayusawa
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | - Toshihide Nakano
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | - Shingo Kasahara
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | - Yuji Hiramatsu
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | - Masaaki Yamagishi
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan; Department of Health Policy and Management, Keio University School of Medicine, Tokyo, Japan
| | - Hiroyuki Yamagishi
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
| | - Kisaburo Sakamoto
- Japanese Society of Pediatric Cardiology and Cardiac Surgery, Tokyo, Japan
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Commentary: Safety in numbers. J Thorac Cardiovasc Surg 2020; 161:1043-1045. [PMID: 32863033 DOI: 10.1016/j.jtcvs.2020.07.058] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 07/17/2020] [Accepted: 07/17/2020] [Indexed: 11/20/2022]
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