SynthesisThe European respiratory journal2025
The volume-outcome relationship for pulmonary endarterectomy in chronic thromboembolic pulmonary hypertension.
Synthesis in The European respiratory journal, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 7 papers.
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Who cites it
7 citing papers in PubMed.
- Pulmonary thromboendarterectomy for chronic thromboembolic disease-a safe but incomplete picture.Journal of thoracic disease · 2026Article
- Valve-sparing Aortic Root Replacement: Defining High-volume Centres Using Prospective Data.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2026Article
- Reproducibility and Consistency of Methods to Define Hospital-Level Procedural Volume Thresholds for Pancreatectomy.Journal of surgical oncology · 2026Article
- Pulmonary endarterectomy for chronic thromboembolic pulmonary hypertension: Technical challenges and controversies.JHLT open · 2025Review
- The Surgical Management of Chronic Thromboembolic Pulmonary Hypertension.Journal of clinical medicine · 2025Review
- The optimal annual case volume for acute type A aortic dissection surgery in relation to long-term outcomes.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025Article
- Effects of postoperative rehabilitation on functional exercise capacity, dyspnea, and quality of life after pulmonary endarterectomy: a systematic review.Journal of Yeungnam medical science · 2025Article
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10 authors.
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No grant is acknowledged in the PubMed record.
Abstract
backgroundWe 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.
methodsThree 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.
resultsWe 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). 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).
conclusionThere 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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