在外科手术和跨导管大动脉置换后的区域护理系统中质量指标的时间变化
Sandra B Lauck1, Maggie Yu1, Aihua Pu2
1University of British Columbia, Vancouver, British Columbia, Canada.
CJC open
|July 27, 2023
概括
透气管大动脉置换 (TAVR) 护理质量显著改善,死亡率降低. 手术性大动脉置换 (SAVR) 显示死亡率始终低. 共识指标为大动脉狭窄治疗质量提供了有价值的见解.
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:
- 从历史上看,对大动脉置换的护理质量监测被分散在跨导管大动脉置换 (TAVR) 和外科大动脉置换 (SAVR) 之间.
- 本研究引入了一种统一的方法,使用共识指标来评估主要大动脉狭窄治疗的护理质量.
- 专注于输TAVR,分离SAVR和SAVR与冠状动脉旁路移植 (CABG) 作为最大体积的手术.
研究的目的:
- 提供关于大动脉狭窄治疗护理质量的全面全球报告.
- 为了比较TAVR和SAVR程序之间的质量指标.
- 评估随着时间的推移,死亡率和其他关键结果的趋势.
主要方法:
- 追溯观察队列研究分析连续患者.
- 对于二次终点来说使用了2012-2019年的数据,对于初级死亡终点来说使用了2015-2019年的数据.
- 采用多变量逻辑回归,并为风险标准化死亡率估计开发了案例混合调整模型.
主要成果:
- 在2015-2019年期间,TAVR程序的比例从32%增加到53%.
- 骨外TAVR患者年龄较大,并发病率较高,但30天死亡率显著下降 (3.1%至0.6%).
- 手术性大动脉置换 (SAVR) 显示了持续低的30天和1年死亡率,随着时间的推移没有显著变化. 风险调整后的外科死亡率保持稳定.
结论:
- 共识质量指标为大动脉狭窄患者的护理质量提供了关键的见解.
- 显示了TAVR护理质量的显著改善,特别是在减少死亡率方面.
- 强调与SAVR相关的持续低死亡率,为比较有效性提供了基准.
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