病院統合がスタンフォードA型急性大動脈解離の緊急手術患者におよぼした影響
［目的］地域医療構想のもと，病院統合再編が行われているが，心臓血管外科診療に及ぼす影響は不明である．当科は2016年に病院統合を経験した．病院統合がA型急性大動脈解離の緊急手術に及ぼした影響を報告する．［方法］2012年5月から2020年12月までのA型急性大動脈解離緊急手術89例を対象とした．検討項目は，術前患者因子，手術件数，手術死亡，紹介率，患者搬送時間，搬送距離，若手心臓血管外科医の執刀数，手術の時間外勤務とした．統合前（P群：29例）と統合後（A群：60例）に分け後方視的に2群比較した．［結果］術前因子は両群に有意差はなかった．手術件数は，P群29例，A群60例であり，統合後に増加し...
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| Published in | 日本心臓血管外科学会雑誌 Vol. 53; no. 2; pp. 49 - 55 |
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| Main Authors | , , , , , , , |
| Format | Journal Article |
| Language | Japanese |
| Published |
特定非営利活動法人 日本心臓血管外科学会
15.03.2024
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| Subjects | |
| Online Access | Get full text |
| ISSN | 0285-1474 1883-4108 |
| DOI | 10.4326/jjcvs.53.49 |
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| Abstract | ［目的］地域医療構想のもと，病院統合再編が行われているが，心臓血管外科診療に及ぼす影響は不明である．当科は2016年に病院統合を経験した．病院統合がA型急性大動脈解離の緊急手術に及ぼした影響を報告する．［方法］2012年5月から2020年12月までのA型急性大動脈解離緊急手術89例を対象とした．検討項目は，術前患者因子，手術件数，手術死亡，紹介率，患者搬送時間，搬送距離，若手心臓血管外科医の執刀数，手術の時間外勤務とした．統合前（P群：29例）と統合後（A群：60例）に分け後方視的に2群比較した．［結果］術前因子は両群に有意差はなかった．手術件数は，P群29例，A群60例であり，統合後に増加した（p＝0.005）．手術死亡は，P群8例27.6%，A群9例15%で有意差はなかった（p＝0.2）．紹介率は，P群17名（58.6%），A群21名（35%）と有意に低下した（p＝0.04）．症状発症から手術施設到着までの時間は，P群206±201分，A群112±140分で有意に短縮した（p＝0.01）．搬送距離は，P群13.9±14.8 km，A群13.5±16.2 kmと有意差はなかった．若手心臓血管外科医の執刀はP群9例（31%），A群34例（56.7%）で増加した（p＝0.02）．時間外勤務はP群446±154分，A群349±112分で有意に短縮した（p＝0.001）．［結論］病院統合は手術件数増加と大動脈解離の症状発症から病院到着までの時間短縮をもたらした．若手医師の執刀数は増え，時間外勤務も減少した． |
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| AbstractList | ［目的］地域医療構想のもと，病院統合再編が行われているが，心臓血管外科診療に及ぼす影響は不明である．当科は2016年に病院統合を経験した．病院統合がA型急性大動脈解離の緊急手術に及ぼした影響を報告する．［方法］2012年5月から2020年12月までのA型急性大動脈解離緊急手術89例を対象とした．検討項目は，術前患者因子，手術件数，手術死亡，紹介率，患者搬送時間，搬送距離，若手心臓血管外科医の執刀数，手術の時間外勤務とした．統合前（P群：29例）と統合後（A群：60例）に分け後方視的に2群比較した．［結果］術前因子は両群に有意差はなかった．手術件数は，P群29例，A群60例であり，統合後に増加した（p＝0.005）．手術死亡は，P群8例27.6%，A群9例15%で有意差はなかった（p＝0.2）．紹介率は，P群17名（58.6%），A群21名（35%）と有意に低下した（p＝0.04）．症状発症から手術施設到着までの時間は，P群206±201分，A群112±140分で有意に短縮した（p＝0.01）．搬送距離は，P群13.9±14.8 km，A群13.5±16.2 kmと有意差はなかった．若手心臓血管外科医の執刀はP群9例（31%），A群34例（56.7%）で増加した（p＝0.02）．時間外勤務はP群446±154分，A群349±112分で有意に短縮した（p＝0.001）．［結論］病院統合は手術件数増加と大動脈解離の症状発症から病院到着までの時間短縮をもたらした．若手医師の執刀数は増え，時間外勤務も減少した． |
| Author | 中井, 秀和 草木迫, 充 加藤, 大樹 髙橋, 亮太 脇山, 英丘 田中, 陽介 大保, 英文 圓尾, 文子 |
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| References | 9) Wang E, Arnold S, Jones S et al. Quality and safety outcomes of a hospital merger following a full integration at a safety net hospital. JAMA Netw Open 2022; 5: e2142382. 18) Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: part I: from etiology to diagnostic strategies. Circulation 2003; 108: 628-35. 1) Ministry of Health, Labour and Welfare. The regional medical care vision. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000080850.html (Accessed June 13, 2023 2) Japan Medical Association. Japan Medical analysis platform. https://jmap.jp/cities/detail/medical_area/2804 (Accessed June 13, 2023 6) Geospatial Information Authority of Japan. GSI Maps. https://maps.gsi.go.jp/ (Accessed October 10, 2023 13) Inoue Y, Matsuda H, Ogino H et al. Analysis of acute Type A aortic dissection in Japan Registry of Aortic Dissection (JRAD). Ann Thorac Surg 2020; 110: 790-8. 7) Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48: 452-8. 16) Knobloch K, Dehn I, Khaladj N et al. HEMS vs. EMS transfer for acute aortic dissection type A. Air Med J 2009; 28: 146-53. 12) Oda Y, Nakamura Y. Impact in the emergency medical system due to the scale reduction of regional core hospitals. J Jpn Soc Emerg Med 2022; 25: 540-5. 17) Manzur M, Han SM, Dunn J et al. Management of patients with acute aortic syndrome through a regional rapid transport system. J Vasc Surg 2017; 65: 21-9. 20) Zaschke L, Habazettl H, Thurau J et al. Acute type A aortic dissection: aortic dissection detection risk score in emergency care-surgical delay because of initial misdiagnosis. Eur Heart J Acute Cardiovasc Care 2020; 9: S40-7. 3) Okita Y. Current surgical results of acute type A aortic dissection in Japan. Ann Cardiothorac Surg 2016; 5: 368-76. 11) Sakaida H, Goto F, Yamamoto A et al. Initial result of stroke care at the stroke center in a new hospital opened by the merger of three facilities with different management bases: effect of stroke center on mechanical thrombectomy. J Neuroendovasc Ther 2021; 15: 712-8. 5) Czerny M, Siepe M, Beyersdorf F et al. Prediction of mortality rate in acute type A dissection: the German registry for acute type A aortic dissection score. Eur J Cardiothorac Surg 2020; 58: 700-6. 19) Saha S, Fabry TG, Peterss S et al. Time is of the essence: where can we improve care in acute aortic dissection ?. Interact Cardiovasc Thorac Surg 2021; 33: 941-8. 4) Yamaguchi T, Nakai M, Ogino H et al. Current status of the management and outcomes of acute aortic dissection in Japan: analyses of nationwide Japanese registry of all cardiac and vascular diseases—diagnostic procedure combination data. Eur Heart J Acute Cardiovasc Care 2020; 9: S21-31. 8) Beaulieu N, Dafny L, Landon B et al. Changes in quality of care after hospital mergers and acquisitions. N Engl J Med 2020; 382: 51-9. 14) Izumisawa Y, Endo H, Motomura N et al. Association between prehospital transfer distance and surgical mortality in emergency thoracic aortic surgery. J Thorac Cardiovasc Surg 2022; 163: 28-35. 21) Hata A, Yanagawa M, Yamagata K et al. Deep learning algorithm for detection of aortic dissection on non-contrast-enhanced CT. Eur Radiol 2021; 31: 1151-9. 15) Yamasaki M, Yoshino H, Takayama M et al. Outcomes of type A acute aortic dissection with cardiopulmonary arrest: Tokyo Acute Aortic Super-network Registry. Eur J Cardiothorac Surg 2023; 63: ezad 056. 22) Okada K, Yamanaka K. Kobe Daigaku shinnzoukekkanngeka gakukouza de sodateru. Kyobu Geka 2023; 76: 379-83. 10) Mariani M, Grazia Sisti L, Isonne C et al. Impact of hospital mergers: a systematic review focusing on healthcare quality measures. Eur J Publ Health 2022; 32: 191-9. |
| References_xml | – reference: 2) Japan Medical Association. Japan Medical analysis platform. https://jmap.jp/cities/detail/medical_area/2804 (Accessed June 13, 2023) – reference: 7) Kanda Y. Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics. Bone Marrow Transplant 2013; 48: 452-8. – reference: 20) Zaschke L, Habazettl H, Thurau J et al. Acute type A aortic dissection: aortic dissection detection risk score in emergency care-surgical delay because of initial misdiagnosis. Eur Heart J Acute Cardiovasc Care 2020; 9: S40-7. – reference: 21) Hata A, Yanagawa M, Yamagata K et al. Deep learning algorithm for detection of aortic dissection on non-contrast-enhanced CT. Eur Radiol 2021; 31: 1151-9. – reference: 11) Sakaida H, Goto F, Yamamoto A et al. Initial result of stroke care at the stroke center in a new hospital opened by the merger of three facilities with different management bases: effect of stroke center on mechanical thrombectomy. J Neuroendovasc Ther 2021; 15: 712-8. – reference: 18) Nienaber CA, Eagle KA. Aortic dissection: new frontiers in diagnosis and management: part I: from etiology to diagnostic strategies. Circulation 2003; 108: 628-35. – reference: 10) Mariani M, Grazia Sisti L, Isonne C et al. Impact of hospital mergers: a systematic review focusing on healthcare quality measures. Eur J Publ Health 2022; 32: 191-9. – reference: 17) Manzur M, Han SM, Dunn J et al. Management of patients with acute aortic syndrome through a regional rapid transport system. J Vasc Surg 2017; 65: 21-9. – reference: 8) Beaulieu N, Dafny L, Landon B et al. Changes in quality of care after hospital mergers and acquisitions. N Engl J Med 2020; 382: 51-9. – reference: 12) Oda Y, Nakamura Y. Impact in the emergency medical system due to the scale reduction of regional core hospitals. J Jpn Soc Emerg Med 2022; 25: 540-5. – reference: 1) Ministry of Health, Labour and Welfare. The regional medical care vision. https://www.mhlw.go.jp/stf/seisakunitsuite/bunya/0000080850.html (Accessed June 13, 2023) – reference: 16) Knobloch K, Dehn I, Khaladj N et al. HEMS vs. EMS transfer for acute aortic dissection type A. Air Med J 2009; 28: 146-53. – reference: 15) Yamasaki M, Yoshino H, Takayama M et al. Outcomes of type A acute aortic dissection with cardiopulmonary arrest: Tokyo Acute Aortic Super-network Registry. Eur J Cardiothorac Surg 2023; 63: ezad 056. – reference: 4) Yamaguchi T, Nakai M, Ogino H et al. Current status of the management and outcomes of acute aortic dissection in Japan: analyses of nationwide Japanese registry of all cardiac and vascular diseases—diagnostic procedure combination data. Eur Heart J Acute Cardiovasc Care 2020; 9: S21-31. – reference: 14) Izumisawa Y, Endo H, Motomura N et al. Association between prehospital transfer distance and surgical mortality in emergency thoracic aortic surgery. J Thorac Cardiovasc Surg 2022; 163: 28-35. – reference: 19) Saha S, Fabry TG, Peterss S et al. Time is of the essence: where can we improve care in acute aortic dissection ?. Interact Cardiovasc Thorac Surg 2021; 33: 941-8. – reference: 3) Okita Y. Current surgical results of acute type A aortic dissection in Japan. Ann Cardiothorac Surg 2016; 5: 368-76. – reference: 6) Geospatial Information Authority of Japan. GSI Maps. https://maps.gsi.go.jp/ (Accessed October 10, 2023) – reference: 5) Czerny M, Siepe M, Beyersdorf F et al. Prediction of mortality rate in acute type A dissection: the German registry for acute type A aortic dissection score. Eur J Cardiothorac Surg 2020; 58: 700-6. – reference: 13) Inoue Y, Matsuda H, Ogino H et al. Analysis of acute Type A aortic dissection in Japan Registry of Aortic Dissection (JRAD). Ann Thorac Surg 2020; 110: 790-8. – reference: 9) Wang E, Arnold S, Jones S et al. Quality and safety outcomes of a hospital merger following a full integration at a safety net hospital. JAMA Netw Open 2022; 5: e2142382. – reference: 22) Okada K, Yamanaka K. Kobe Daigaku shinnzoukekkanngeka gakukouza de sodateru. Kyobu Geka 2023; 76: 379-83. |
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| SubjectTerms | 地域医療構想 急性大動脈症候群 急性大動脈解離 病院統合 |
| Title | 病院統合がスタンフォードA型急性大動脈解離の緊急手術患者におよぼした影響 |
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