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量と結果の関係と腹部大動脈動脈瘤の修復
Bruce E Landon1, A James O'Malley, Kristina Giles
1Department of Health Care Policy, Harvard Medical School, 180 Longwood Ave, Boston, MA 02215, USA. landon@hcp.med.harvard.edu
Circulation
|September 15, 2010
まとめ
より大きな手術容量は,開いた腹部大動脈動脈瘤 (AAA) の修復のための結果を改善します. 血管内部のAAA修復は,低い値の後,体積-結果の利益が少ないことを示し,注意深い推薦決定を必要とします.
科学分野:
- 血管外科 血管外科
- 医療サービス 研究 医療サービス
- アウトカム 研究成果 研究成果
背景:
- 処置の容量は患者の結果と関連していますが,複数の治療法があるため複雑です.
- ある状態に対する異なる外科的アプローチを比較する際には,臨床的意思決定が困難になります.
研究 の 目的:
- オープンおよび内血管性腹腔大動脈動脈瘤 (AAA) の修復のための機関容量とアウトカムとの関係を調査する.
- AAAの修復容量の動向と,その影響が医師の推薦に及ぼす影響を分析する.
主な方法:
- 230,736 AAA修理のメディケアデータ (2001年~2006年) を利用しました.
- 傾向スコアマッチしたコホート (2001-2004) を用いて評価された結果.
- オープンおよび内血管性AAA修復のための機関容量の傾向を調べた.
主要な成果:
- 血管内部のAAA修復の割合は,2001年から2006年の間に22%から50%以上に上昇しました.
- 大規模なセンターへ向けての処置容量の小さなシフトが発生しました.
- 調整された死亡率は,オープンおよび内血管修復の両方の容量の増加に伴い減少し,内血管手術の容量の減少に伴い,より大きな利益が見られた.
結論:
- 生存率は,開いた修復量の増加とともに着実に改善します.
- 血管内修復は,低体積の値を超えた結果の改善が限られていることを示しています.
- 医師は,非譲渡可能な経験のためにAAA修復の推薦決定をする際に,オープンおよび内血管の両方を考慮する必要があります.
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