外科治療の監視と評価:手術後の死亡率の定義とデータ収集の標準化
Charlotta L Palmqvist1, Roshan Ariyaratnam2, David A Watters3
1Department of Clinical Sciences in Lund, Paediatric Surgery and Global Paediatrics, Faculty of Medicine, Lund University, Lund, Sweden; The Alfred Hospital and Monash University, Melbourne, VIC, Australia.
Lancet (London, England)
|August 28, 2015
まとめ
術後の死亡率 (POMR) は,病院での死亡と処置を分母として用いて,洗練されたシステムなしで計算できます. 標準化されたデータ収集は 手術の結果の正確な監視に不可欠です
科学分野:
- 手術 結果 研究
- 医療情報学
- 公衆衛生の監視
背景:
- 術後の死亡率 (POMR) と症例数は,手術サービスのモニタリングに不可欠です.
- タイミング,分母,リスク調整を含むPOMR測定のための標準化されたアプローチは欠けている.
- これらの制限に対処するために,様々な外科データセットの分析が必要です.
研究 の 目的:
- 4つの大きな手術データセットを 分析する
- POMR測定の標準化に伴う課題に対処する.
- 一貫したデータ収集のための最低限のデータセットを推奨する.
主な方法:
- ニュージーランド,オーストラリア,南アフリカ,パプアニューギニアのデータを活用した.
- データの完全性,日付の誤り,コード化基準の評価
- 病院内および30日間の死亡率,入院エピソード対処置を分母として使用してPOMRを計算した.
- リスク調整分析のためのロジスティック回帰を実行します.
主要な成果:
- 130万件以上の入院と150万件の処置; 30日以内に8655人の死亡.
- データベースの完全性とコード化基準の有意な差異が認められた.
- 病院でのPOMRは30日間のPOMRを過小評価した.分母選択は10~70%の結果に影響した.
- 年齢と緊急入院はPOMRに有意な影響を及ぼしたが,リスク調整は相対的なサイト確率に最小の影響を及ぼした.
結論:
- 病院は先進的な電子システムなしで 症例数とPOMRの重要なデータを収集できます
- 病院内でのPOMRは,データ制限のため,分母として手順が推奨されます.
- 含有基準,定義,データ精度 (特に日付) の標準化は不可欠です.
- シンプルで標準化されたデータ収集フォームは,世界的にPOMRのモニタリングを改善することができます.
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