主要手術における救済失敗の病院間格差
David Schwappach1, Marcel Zwahlen1, Michael M Havranek2
1Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
JAMA network open
|February 4, 2026
まとめ
合併症を発症した外科患者の約5人に1人が死亡しており、救済失敗(FTR)率の病院間での著しいばらつきが示されている。施設ごとの成績は、1000人以上の回避可能な死亡に関与しており、FTRが主要な患者安全指標であることが強調されている。
科学分野:
- ヘルスケアの質と安全
- 外科患者の転帰
- ヘルスサービスリサーチ
背景:
- 救済失敗(FTR)は、治療可能な合併症に続発する術後死亡率と定義され、重大な患者安全上の懸念事項です。
- FTRは、患者の悪化を管理する施設の能力を反映し、質指標として提案されています。
- 米国以外でのFTRの体系的な病院レベルのばらつきに関するエビデンスは限られています。
主な方法:
- スイス(2019-2023年)の管理病院データを使用した後ろ向きコホート研究。
- 特定の合併症を持つ外科入院患者に、医療研究・品質庁(AHRQ)の患者安全指標04(PSI04)の定義を適用しました。
- 病院レベルのばらつきと成績を評価するために、多レベルロジスティック回帰とRSMRを利用しました。
結論:
- 外科的合併症に続発する救済失敗率には、病院間でかなりのばらつきが存在します。
- 施設ごとの成績は患者の転帰に大きく影響し、かなりの数の死亡が回避可能である可能性があります。
- FTRは価値ある国際的な患者安全指標として機能し、成績のばらつきを駆動する組織的要因の調査が必要です。
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