在支架时代进行皮肤冠状动脉干预的体积-结果关系
Edward L Hannan1, Chuntao Wu, Gary Walford
1State University of New York, Albany, NY, USA. elh03@health.state.ny.us
Circulation
|August 17, 2005
概括
通过皮肤冠状动脉干预 (PCI) 的医院和操作员数量较高与更好的患者结果有关. 这项研究证实,医院和运营商的程序量增加减少了与PCI程序相关的风险.
科学领域:
- 心血管医学 心血管医学
- 干预心脏病学 干预心脏病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 截皮冠状动脉干预 (PCI) 现有的体积值是在支架安置被广泛采用之前确立的.
- 医院和运营商程序量对PCI结果的影响需要在现代干预实践的背景下进行更新的分析.
研究的目的:
- 评估每年医院和操作员数量与皮肤穿透冠状动脉干预 (PCI) 后的关键结果之间的关联.
- 为了确定更高的手术体积是否与降低的住院死亡率相关,同一天的冠状动脉旁路移植手术 (CABG) 和同一住院的CABG手术.
主要方法:
- 来自纽约皮肤冠状动脉干预报告系统 (1998-2000) 的数据分析,其中包括107,713例PCI病例.
- 根据患者的疾病严重程度进行了风险调整,以隔离手术体积的影响.
- 基于预定义的医院体量 (每年400次手术) 和操作员体量 (每年75次手术) 值,对结果的检查.
主要成果:
- 低体量医院 (<400次/年) 与高体量医院相比,在医院内死亡率 (OR=1.98),同一天CABG (OR=2.07) 和同一住院CABG (OR=1.51) 的几率明显更高.
- 低量运营商 (<75个程序/年) 与高量运营商相比,同日CABG (OR=1.65) 和同住CABG (OR=1.55) 的几率明显更高;运营商的数量与死亡率没有显著联系.
- 结合较低的医院和操作员体积 (分别<400和<75),与高体积同龄人相比,死亡率 (5.92x),同一天CABG (4.02x) 和同一住宿CABG (3.92x) 的几率大幅增加.
结论:
- 医院和运营商的每年更高的程序量独立地与皮肤冠状动脉干预的风险调整结果的改善有关.
- 这些发现支持基于数量的策略在优化PCI程序的护理质量和患者安全方面的持续重要性.
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