日本小児循環器学会アンケートを活用した右室流出路–肺動脈領域における術後再治療介入の調査および医療費の試算

Shintaro Nemoto; 根本慎太郎; Yutaka Odanaka; 小田中豊; Kanta Kishi; 岸勘太; Hayato Konishi; 小西隼人; Akiyo Suzuki; 鈴木昌代; Atsuko Ashida; 蘆田温子; Noriyasu Ozaki; 尾崎智康; Masaru Miura; 三浦大

doi:10.9794/jspccs.39.91

日本小児循環器学会アンケートを活用した右室流出路–肺動脈領域における術後再治療介入の調査および医療費の試算National Survey by the Japanese Society of Pediatric Cardiology and Cardiac Surgery for an Overview of Re-Interventions after Surgical Reconstruction of the Right Ventricular Outflow Tract and/or Pulmonary Artery and an Estimation of Their Medical Cost

根本慎太郎^1,4，小田中豊²，岸勘太²，小西隼人¹，鈴木昌代¹，蘆田温子²，尾崎智康²，三浦大^3,4Shintaro Nemoto^1,4, Yutaka Odanaka², Kanta Kishi², Hayato Konishi¹, Akiyo Suzuki¹, Atsuko Ashida², Noriyasu Ozaki², Masaru Miura^3,4

¹ 大阪医科薬科大学病院小児心臓血管外科Department of Pediatric Cardiovascular Surgery, Osaka Medical and Pharmaceutical University Hospital ◇ Takatsuki, Osaka, Japan

² 大阪医科薬科大学病院小児科Department of Pediatric, Osaka Medical and Pharmaceutical University Hospital ◇ Takatsuki, Osaka, Japan

³ 東京都立小児総合医療センター循環器科Department of Cardiology, Tokyo Metropolitan Children’s Medical Center ◇ Tokyo, Japan

⁴ 日本小児循環器学会臨床試験委員会Clinical Trials Committee, Japanese Society of Pediatric Cardiology and Cardiac Surgery (JSPCC)

受付日：2023年1月13日Received: January 13, 2023

受理日：2023年5月14日Accepted: May 14, 2023

発行日：2023年8月1日Published: August 1, 2023

背景：右室流出路–肺動脈領域の術後再治療介入は未だに解決しなければならない課題である．本研究では，全国アンケートを利用し，レジストリから抽出の困難な本再介入の実態を調査し，医療経済的観点からの影響を調査した．

方法：日本小児循環器学会によるウェブアンケート（2020年2月）による実態調査を実施し，大阪医科薬科大学病院における再介入医療費調査を算出した．

結果：31施設（日本小児循環器学会評議員が在籍する手術実施49施設，回答率63.3％）から回答を得た．直近3年間での当該手術総数は2,520件（自己心膜54.4％，polytetrafluoroethylene 35.8％，ウシ心膜9.8％）であり，段階的手術を除いた再介入は500件（再手術47.6％，カテーテル治療52.4％）であった．すべての材料に共通する再介入の三大原因は，材料劣化，内膜過剰増生，および非伸張性であった．実際の再介入治療費は平均約600万円/件で，アンケートからの実施数を乗じると31施設では約10億円/年，全国90の手術実施施設では約30億円/年と試算された．

結語：当該領域の術後再治療介入は医療経済上も看過できない課題である．更なる回避には手術術式および手術材料の最適化と改良が引き続き必要と考えられた．

Background: Re-interventions must be avoided after surgical correction of the right ventricular outflow tract (RVOT) and/or pulmonary artery (PA). This study aimed to examine the status focusing the surgical material used and to estimate the economic impact of re-interventions.

Methods: The Japanese Society of Pediatric Cardiology and Cardiac Surgery (JSPCC) performed a web-based survey. This study calculated the actual medical costs of the re-interventions performed at Osaka Medical and Pharmaceutical University Hospital.

Results: Responses were collected from 31/49 (63.3％) core hospitals in Japan. This study revealed 2,520 relevant RVOT/PA surgeries and 500 re-interventions, 238 (47.6％) re-operations, and 262 (52.4％) catheter interventions in the last 3 years. Surgical materials included autologous pericardium (n＝272, 54.5％), polytetrafluoroethylene (n＝179, 35.8％), and glutaraldehyde-treated bovine pericardium (n＝49, 9.8％). Most re-interventions for a failed autologous pericardium were performed relatively early postoperatively. Those for the other two materials occurred throughout the postoperative period, but especially after five years. Degradation, excess intimal proliferation, and inextensibility are the adverse changes in materials. The average medical cost of re-interventions was 6 million yen per case. This yield estimated annual expenses for re-interventions of approximately 900 million yen at the 31 hospitals and approximately 2.7 billion yen at 90 centers nationwide.

Conclusion: The JSPCC questionnaire helped understand the status of re-interventions after RVOT/PA repair using existing surgical materials. The total medical costs for the re-interventions should not be overlooked in the national healthcare system.

Key words: congenital heart disease; right ventricular outflow tract; pulmonary artery; re-intervention; surgical materials

日本小児循環器学会雑誌 Pediatric Cardiology and Cardiac Surgery

原著Original