The volume–outcome relationship for pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension Article Swipe
Samuel Heuts
,
Michał Kawczyński
,
Alet J.G. Leus
,
Laurent Godinas
,
Catharina Belge
,
Vanessa van Empel
,
Bart Meyns
,
Jos G. Maessen
,
Marion Delcroix
,
Tom Verbelen
·
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1183/13993003.01865-2024
YOU?
·
· 2024
· Open Access
·
· DOI: https://doi.org/10.1183/13993003.01865-2024
Background We conducted a volume–outcome meta-analysis of pulmonary endarterectomy procedures for chronic thromboembolic pulmonary hypertension to objectively determine the minimum required annual case load that can define a high-volume centre. Methods Three electronic databases were systematically queried up to 1 May 2024. Centres were divided in volume tertiles. 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. Long-term survival was assessed using Cox frailty models. Results We included 51 centres (52 consecutive cohorts) and divided them into tertiles (T1: 15 cases per year), comprising a total 11 345 patients (mean age 52.3 years). 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. 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). In addition, a significant volume effect was observed for long-term survival (adjusted hazard ratio per tertile 0.75, 95% CI 0.63–0.89; p=0.001). Conclusion There is a significant association between procedural volume and early mortality in pulmonary endarterectomy. 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.
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Metadata
- Type
- review
- Language
- en
- Landing Page
- https://doi.org/10.1183/13993003.01865-2024
- OA Status
- green
- Cited By
- 8
- References
- 40
- Related Works
- 10
- OpenAlex ID
- https://openalex.org/W4404585467
All OpenAlex metadata
Raw OpenAlex JSON
- OpenAlex ID
-
https://openalex.org/W4404585467Canonical identifier for this work in OpenAlex
- DOI
-
https://doi.org/10.1183/13993003.01865-2024Digital Object Identifier
- Title
-
The volume–outcome relationship for pulmonary endarterectomy in chronic thromboembolic pulmonary hypertensionWork title
- Type
-
reviewOpenAlex work type
- Language
-
enPrimary language
- Publication year
-
2024Year of publication
- Publication date
-
2024-11-21Full publication date if available
- Authors
-
Samuel Heuts, Michał Kawczyński, Alet J.G. Leus, Laurent Godinas, Catharina Belge, Vanessa van Empel, Bart Meyns, Jos G. Maessen, Marion Delcroix, Tom VerbelenList of authors in order
- Landing page
-
https://doi.org/10.1183/13993003.01865-2024Publisher landing page
- Open access
-
YesWhether a free full text is available
- OA status
-
greenOpen access status per OpenAlex
- OA URL
-
https://www.ncbi.nlm.nih.gov/pmc/articles/11865742Direct OA link when available
- Concepts
-
Medicine, Confidence interval, Hazard ratio, Pulmonary hypertension, Internal medicine, Cardiology, Proportional hazards model, Volume (thermodynamics), Surgery, Quantum mechanics, PhysicsTop concepts (fields/topics) attached by OpenAlex
- Cited by
-
8Total citation count in OpenAlex
- Citations by year (recent)
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2025: 8Per-year citation counts (last 5 years)
- References (count)
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40Number of works referenced by this work
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10Other works algorithmically related by OpenAlex
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