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医院体积与先天性心脏手术结果之间的当代关系
Karl F Welke1, Tara Karamlou2, Sean M O'Brien3
1Division of Pediatric Cardiothoracic Surgery, Atrium Health Levine Children's Hospital, Charlotte, North Carolina.
在先天性心脏手术 (CHS) 中,更高的医院体积与更好的结果有关,特别是在复杂的程序中. 较低体积的中心显示死亡率增加,救援失败率增加.
科学领域:
- 心血管外科心血管外科
- 儿科手术 儿科手术
- 医疗保健服务研究 医疗服务研究
背景情况:
- 由于护理的进步,先天性心脏手术 (CHS) 的医院体积和结果之间的关系需要更新分析.
- 近几十年来,死亡率和CHS病例混合调整方法的演变有显著下降.
研究的目的:
- 研究先天性心脏手术中医院体积和患者结果之间的当前关联.
- 为了确定CHS的体积-结果关系中的特定值或模式.
主要方法:
- 胸腔外科医生协会-先天性心脏手术数据库 (2017-2020) 的分析,包括年龄小于18岁的患者.
- 贝叶斯分层模型被用来评估年度医院容量与调整后手术死亡率,重大并发症,救援失败 (FTR) 和术后停留时间 (PLOS) 之间的关联.
- 分层分析是由胸腔外科医生协会-欧洲心胸外科协会 (STAT) 类别和诺伍德手术进行的.
主要成果:
- 总共分析了101个中心和76,714个指数交易,年中位数为144个交易.
- 手术死亡率为2.7%,在体积较小的医院观察到的比率更高,显示出大约190次手术/年以下的显着增加.
- 在STAT 4-5手术和诺伍德手术中,体积与结果的关联性更为明显,影响死亡率和FTR,而PLOS和整体并发症的体积依赖性较小.
结论:
- 医院的外科手术量与先天性心脏手术中的死亡率和救援失败有显著的关联.
- 在高风险的先天性心脏手术中,体积与结果的关系特别强烈.
- 结果提供了支持旨在优化CHS医疗保健质量和患者结果的倡议的证据.
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