在目前的美国外科实践中,增加手术前压力测试的使用与减少心脏不良事件无关
Jesse A Columbo1,2,3, Salvatore T Scali4,5,6, Dan Neal4,5,6
1Geisel School of Medicine at Dartmouth, Hanover, NH.
Annals of surgery
|June 15, 2023
概括
增加手术前压力测试并没有减少大手术患者的心脏事件. 较低的测试率与较少的重大心脏不良事件 (MACE) 和显著的成本节省有关,这表明需要更有选择性的测试.
科学领域:
- 心脏病学 心脏病学
- 医疗保健服务研究 医疗服务研究
- 在外科手术期间的医学.
背景情况:
- 在美国医疗保健中心的手术前压力测试实践中存在显著的差异.
- 术前压力测试频率与术后心脏事件之间的关联仍然不清楚.
研究的目的:
- 评估在接受重大选择性手术的患者中进行手术前压力测试的频率.
- 确定手术前压力测试的更高率是否与手术前心脏事件减少相关.
主要方法:
- 分析了2015-2019年期间接受8种类型的大型选择性手术 (一般,血管,瘤) 的185,612名患者的数据.
- 根据手术前压力测试频率,中心被分为五分之一.
- 医院内主要不良心脏事件 (MACE),心肌梗塞 (MI) 和这些五分位数的成本的比较,根据患者风险进行调整,使用修改后的心脏风险指数 (mRCRI).
主要成果:
- 术前压力测试的差异很大,从1.7%到22.5%的中心,尽管患者的风险概况相似 (mRCRI>1:15.0%对15.8%).
- 住院MACE率在压力测试频率最低的中心 (8.2%) 与最高 (9.4%) 相比较较低.
- 所有五分之一 (0.5%) 的心肌梗塞 (MI) 发生率相似. 观察到显著的成本差异,更高的测试中心承担的费用要高得多 (每1000名患者357300美元和26996美元).
结论:
- 无论患者的风险如何,在全国范围内,手术前压力测试的实质性差异仍然存在.
- 术前压力测试的更高率与术后MACE或MI的减少无关.
- 选择性压力测试可以通过尽量减少不必要的程序来提供降低成本的机会.
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