重新入院目的地和重大手术后的死亡风险:观察性队列研究
Benjamin S Brooke1, Philip P Goodney2, Larry W Kraiss3
1Department of Surgery, University of Utah School of Medicine, Salt Lake City, UT, USA; IDEAS Center, VA Salt Lake City Health Care System, Salt Lake City, UT, USA.
Lancet (London, England)
|June 22, 2015
概括
重新入院的患者在接受手术的医院中显示出改善的生存率. 大型手术后返回指数医院接受护理可以降低死亡风险.
科学领域:
- 手术结果和患者安全.
- 医疗服务研究 医疗服务研究
- 手术并发症的流行病学.
背景情况:
- 大型外科手术后,重入医院的情况很常见.
- 再接收目的地对患者结果的影响仍然不清楚.
- 这项研究调查了美国医疗保险受益人再接收地点和死亡风险之间的关联.
研究的目的:
- 检查再接收目的地 (指数与非指数医院) 与死亡风险之间的关系.
- 评估医疗保险受益者在需要再入院的大型手术后的结果.
- 为医疗保健政策提供有关术后护理和医院网络的信息.
主要方法:
- 对从2001年至2011年接受12次常见重大手术的患者的医疗保险索赔数据的分析.
- 使用后勤回归与反向概率权重和仪器变量分析.
- 评估与重新入院的90天死亡风险与指数医院相比,与非指数医院相比.
主要成果:
- 重新入住指数医院与90天死亡率降低26%的风险相关 (OR 0.74).
- 在所有研究的手术中,这种生存益处是显著的,特别是在胰腺切除手术和大脑关节绕道手术中.
- 仪器变量分析表明,患者返回指数医院的可能性更高,死亡风险降低了8%.
结论:
- 在手术发生的医院重新入院的患者在美国表现出更好的生存率.
- 这些发现表明,在大手术后,指数医院的护理连续性可以改善患者的治疗结果.
- 结果对优化专注于成本效益和生存的区域化外科护理策略有影响.
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