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Surgical volume and outcomes of surgical ablation for atrial fibrillation: a nationwide population-based cohort study

BACKGROUND: Atrial fibrillation is the most common cardiac arrythmia and causes many complications. Sinus rhythm restoration could reduce late mortality of atrial fibrillation patients. The Maze procedure is the gold standard for surgical ablation of atrial fibrillation. Higher surgical volume has b...

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Autores principales: Chang, Feng-Cheng, Huang, Yu-Tung, Wu, Victor Chien-Chia, Tu, Hui-Tzu, Lin, Chia-Pin, Yeh, Jih-Kai, Cheng, Yu-Ting, Chang, Shang-Hung, Chu, Pao-Hsien, Chou, An-Hsun, Chen, Shao-Wei
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922454/
https://www.ncbi.nlm.nih.gov/pubmed/36774460
http://dx.doi.org/10.1186/s12872-023-03101-5
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author Chang, Feng-Cheng
Huang, Yu-Tung
Wu, Victor Chien-Chia
Tu, Hui-Tzu
Lin, Chia-Pin
Yeh, Jih-Kai
Cheng, Yu-Ting
Chang, Shang-Hung
Chu, Pao-Hsien
Chou, An-Hsun
Chen, Shao-Wei
author_facet Chang, Feng-Cheng
Huang, Yu-Tung
Wu, Victor Chien-Chia
Tu, Hui-Tzu
Lin, Chia-Pin
Yeh, Jih-Kai
Cheng, Yu-Ting
Chang, Shang-Hung
Chu, Pao-Hsien
Chou, An-Hsun
Chen, Shao-Wei
author_sort Chang, Feng-Cheng
collection PubMed
description BACKGROUND: Atrial fibrillation is the most common cardiac arrythmia and causes many complications. Sinus rhythm restoration could reduce late mortality of atrial fibrillation patients. The Maze procedure is the gold standard for surgical ablation of atrial fibrillation. Higher surgical volume has been documented with favorable outcomes of various cardiac procedures such as mitral valve surgery and aortic valve replacement. We aimed to determine the volume–outcome relationship (i.e., association between surgical volume and outcomes) for the concomitant Maze procedure during major cardiac surgeries. METHODS: This nationwide population-based cohort study retrieved data from the Taiwan National Health Insurance Research Database. Adult patients undergoing concomitant Maze procedures during 2010–2017 were identified; consequently, 2666 patients were classified into four subgroups based on hospital cumulative surgery volumes. In-hospital outcomes and late outcomes during follow-up were analyzed. Logistic regression and Cox proportional hazards model were used to analyze the volume–outcome relationship. RESULTS: Patients undergoing Maze procedures at lower-volume hospitals tended to be frailer and had higher comorbidity scores. Patients in the highest-volume hospitals had a lower risk of in-hospital mortality than those in the lowest-volume hospitals [adjusted odds ratio, 0.30; 95% confidence interval (CI), 0.15–0.61; P < 0.001]. Patients in the highest-volume hospitals had lower rates of late mortality than those in the lowest-volume hospitals, including all-cause mortality [adjusted hazard ratio (aHR) 0.53; 95% CI 0.40–0.68; P < 0.001] and all-cause mortality after discharge (aHR 0.60; 95% CI 0.44–0.80; P < 0.001). CONCLUSIONS: A positive hospital volume–outcome relationship for concomitant Maze procedures was demonstrated for in-hospital and late follow-up mortality. The consequence may be attributed to physician skill/experience, experienced multidisciplinary teams, and comprehensive care processes. We suggest referring patients with frailty or those requiring complicated cardiac surgeries to high-volume hospitals to improve clinical outcomes. Trial registration: the institutional review board of Chang Gung Memorial Hospital approved all data usage and the study protocol (registration number: 202100151B0C502). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-023-03101-5.
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spelling pubmed-99224542023-02-13 Surgical volume and outcomes of surgical ablation for atrial fibrillation: a nationwide population-based cohort study Chang, Feng-Cheng Huang, Yu-Tung Wu, Victor Chien-Chia Tu, Hui-Tzu Lin, Chia-Pin Yeh, Jih-Kai Cheng, Yu-Ting Chang, Shang-Hung Chu, Pao-Hsien Chou, An-Hsun Chen, Shao-Wei BMC Cardiovasc Disord Research BACKGROUND: Atrial fibrillation is the most common cardiac arrythmia and causes many complications. Sinus rhythm restoration could reduce late mortality of atrial fibrillation patients. The Maze procedure is the gold standard for surgical ablation of atrial fibrillation. Higher surgical volume has been documented with favorable outcomes of various cardiac procedures such as mitral valve surgery and aortic valve replacement. We aimed to determine the volume–outcome relationship (i.e., association between surgical volume and outcomes) for the concomitant Maze procedure during major cardiac surgeries. METHODS: This nationwide population-based cohort study retrieved data from the Taiwan National Health Insurance Research Database. Adult patients undergoing concomitant Maze procedures during 2010–2017 were identified; consequently, 2666 patients were classified into four subgroups based on hospital cumulative surgery volumes. In-hospital outcomes and late outcomes during follow-up were analyzed. Logistic regression and Cox proportional hazards model were used to analyze the volume–outcome relationship. RESULTS: Patients undergoing Maze procedures at lower-volume hospitals tended to be frailer and had higher comorbidity scores. Patients in the highest-volume hospitals had a lower risk of in-hospital mortality than those in the lowest-volume hospitals [adjusted odds ratio, 0.30; 95% confidence interval (CI), 0.15–0.61; P < 0.001]. Patients in the highest-volume hospitals had lower rates of late mortality than those in the lowest-volume hospitals, including all-cause mortality [adjusted hazard ratio (aHR) 0.53; 95% CI 0.40–0.68; P < 0.001] and all-cause mortality after discharge (aHR 0.60; 95% CI 0.44–0.80; P < 0.001). CONCLUSIONS: A positive hospital volume–outcome relationship for concomitant Maze procedures was demonstrated for in-hospital and late follow-up mortality. The consequence may be attributed to physician skill/experience, experienced multidisciplinary teams, and comprehensive care processes. We suggest referring patients with frailty or those requiring complicated cardiac surgeries to high-volume hospitals to improve clinical outcomes. Trial registration: the institutional review board of Chang Gung Memorial Hospital approved all data usage and the study protocol (registration number: 202100151B0C502). SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12872-023-03101-5. BioMed Central 2023-02-11 /pmc/articles/PMC9922454/ /pubmed/36774460 http://dx.doi.org/10.1186/s12872-023-03101-5 Text en © The Author(s) 2023 https://creativecommons.org/licenses/by/4.0/Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) . The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/ (https://creativecommons.org/publicdomain/zero/1.0/) ) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research
Chang, Feng-Cheng
Huang, Yu-Tung
Wu, Victor Chien-Chia
Tu, Hui-Tzu
Lin, Chia-Pin
Yeh, Jih-Kai
Cheng, Yu-Ting
Chang, Shang-Hung
Chu, Pao-Hsien
Chou, An-Hsun
Chen, Shao-Wei
Surgical volume and outcomes of surgical ablation for atrial fibrillation: a nationwide population-based cohort study
title Surgical volume and outcomes of surgical ablation for atrial fibrillation: a nationwide population-based cohort study
title_full Surgical volume and outcomes of surgical ablation for atrial fibrillation: a nationwide population-based cohort study
title_fullStr Surgical volume and outcomes of surgical ablation for atrial fibrillation: a nationwide population-based cohort study
title_full_unstemmed Surgical volume and outcomes of surgical ablation for atrial fibrillation: a nationwide population-based cohort study
title_short Surgical volume and outcomes of surgical ablation for atrial fibrillation: a nationwide population-based cohort study
title_sort surgical volume and outcomes of surgical ablation for atrial fibrillation: a nationwide population-based cohort study
topic Research
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9922454/
https://www.ncbi.nlm.nih.gov/pubmed/36774460
http://dx.doi.org/10.1186/s12872-023-03101-5
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