心血管外科手术的体积标准应该只关注高风险患者吗?
Philip P Goodney1, F L Lucas, John D Birkmeyer
1VA Outcomes Group, Department of Veterans Affairs Medical Center, White River Junction, Vt 05009, USA. philip.goodney@hitchcock.org
Circulation
|January 29, 2003
概括
基于体积的心血管手术转诊有利于高风险和低风险患者. 医院的数量对各种手术的手术死亡率产生了重大影响,这表明这些举措应得到更广泛的应用.
科学领域:
- 心血管外科心血管外科
- 医疗保健服务研究 医疗服务研究
- 卫生政策 卫生政策
背景情况:
- 支付者和政策制定者正在探索将心血管程序集中在高体积中心.
- 之前的分析建议将基于体积的转诊专注于高风险患者.
研究的目的:
- 调查医院手术量对主要心血管手术后手术死亡率的影响.
- 确定基于体积的转诊计划是否应仅限于高风险患者群体.
主要方法:
- 从1994年至1999年对国家医疗保险数据库的分析.
- 包括四项心血管手术:CABG,大动脉置换,心心置换和选择性腹部大动脉动脉瘤修复.
- 对于高风险和低风险患者,非常高体量医院 (VHVH) 和非常低体量医院 (VLVH) 之间的手术死亡率的比较.
主要成果:
- 在高风险和低风险患者中,与体积相关的死亡率差异显著.
- 在所有研究的程序中,VHVH和VLVH之间的相对死亡风险在两个风险组中都相似.
- 例如,CABG的相对风险为0.77 (高风险) 和0.78 (低风险).
结论:
- 限制基于体积的转诊计划仅限于高风险患者的理由很少.
- 集中心血管手术在高体积中心的好处似乎也延伸到低风险患者群体.
相关概念视频
Cardiac Output and Stroke Volume
Cardiac output (CO) is an integral aspect of human physiology, reflecting the heart's efficiency and responsiveness to the body's needs. It represents the volume of blood that the left or right ventricle ejects into the aorta or pulmonary trunk each minute. The CO is calculated by multiplying the heart rate (HR)—the number of heartbeats per minute—by the stroke volume (SV)—the amount of blood pumped out with each heartbeat.
In an average resting adult male, the typical cardiac output averages...
In an average resting adult male, the typical cardiac output averages...
Regulation of Stroke Volume
The regulation of stroke volume, which is the amount of blood the heart pumps out during each heartbeat, is critical for maintaining a healthy circulatory system. Stroke volume is influenced by three main factors: preload, contractility, and afterload.
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
Preload refers to the degree of stretch on the heart before it contracts. It's analogous to the stretching of a rubber band; the more it's stretched, the more forcefully it snaps back. This concept is encapsulated in the Frank-Starling law of the...
Cardiac Output II: Effect of Stroke Volume on Cardiac Output
Cardiac output (CO), the amount of blood the heart pumps per minute, is a parameter in cardiovascular physiology determined by stroke volume and heart rate. Stroke volume, the amount of blood pushed from one of the ventricles per heartbeat, is influenced by preload, afterload, and contractility.
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
Preload
Preload refers to the initial elongation of the cardiac myocytes before contraction and is related to the volume of blood filling the heart at the end of diastole, or end-diastolic volume. The...
Cardiomyopathy VII: Pre and Post Operative Nursing Management
Patients with hypertrophic cardiomyopathy (HCM) and left ventricular outflow tract (LVOT) obstruction who remain symptomatic despite optimal medical therapy may undergo a septal myectomy (Morrow procedure). This procedure involves excising a portion of the hypertrophied septum below the aortic valve using a heart-lung machine to improve blood flow through the LVOT. Effective preoperative and postoperative nursing management ensures successful patient outcomes, minimizes complications, and...


