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体积与结果关系和腹腔大动脉动脉瘤修复
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
概括
更高的外科手术容量改善了开放腹腔大动脉瘤 (AAA) 修复的结果. 内血管AAA修复在低值后显示较少的体积-结果益处,需要谨慎的转诊决定.
科学领域:
- 血管外科 血管外科
- 医疗保健服务研究 医疗服务研究
- 研究成果 研究成果 研究成果
背景情况:
- 手术量与患者的治疗结果有关,但这是复杂的,因为有多种治疗选择.
- 当比较不同的手术方法来治疗某种疾病时,临床决策受到挑战.
研究的目的:
- 调查机构体积与开放和内血管腹腔大动脉瘤 (AAA) 修复的结果之间的关系.
- 分析AAA修复量趋势及其对医生转诊的影响.
主要方法:
- 使用的医疗保险数据 (2001年至2006年) 为230,736次AAA维修.
- 使用倾向性得分匹配的队列 (2001-2004) 评估结果.
- 对开放和内血管AAA修复的机构体积的研究趋势.
主要成果:
- 在2001年至2006年期间,内血管AAA修复比例从22%上升到50%以上.
- 在手术量向大批量中心转移的过程中发生了很小的转变.
- 调整后的死亡率随着开放和内血管修复的体积增加而下降,在内血管手术的较低体积下看到的益处更大.
结论:
- 随着开放修复体积的增加,生存率稳步提高.
- 血管内修复显示,在低体积值之后,结果的改善有限.
- 医生必须考虑开放和内血管的选项在做AAA修复转诊决定时,由于不可转移的经验.
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