医院未能救援的实用性,用于分析儿科术后死亡率的变化
Steven C Mehl1,2, Jorge I Portuondo1, Yao Tian3,4
1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, TX.
概括
儿童医院的救援失败率 (FTR) 较高,即使没有并发症,患者死亡率也会增加. 改善FTR实践可能会减少儿科手术中的整体术后死亡.
科学领域:
- 儿科手术 儿科手术
- 改善医疗保健质量 改善医疗保健质量
- 患者安全 患者安全
背景情况:
- 救助失败 (FTR) 是手术质量的关键指标,定义为手术后并发症后的术后死亡率.
- 评估FTR与无并发症患者的死亡率的关联对于理解其对儿科外科结果的更广泛影响至关重要.
研究的目的:
- 评估儿科医院在救援失败 (FTR) 的表现与没有出现并发症的儿科手术患者的死亡率之间的关系.
- 为了确定具有更高FTR率的医院是否也会在没有手术并发症的患者中增加死亡率.
主要方法:
- 追溯队列研究分析了2012年至2020年间48家学术儿科医院的数据.
- 包括接受57次高风险手术的儿童;医院按可靠性调整的FTR五分位数分层.
- 多变量等级回归用于检查在没有并发症的患者中医院FTR性能和死亡率之间的关联.
主要成果:
- 在表现最低和表现最高的医院之间观察到可靠性调整后FTR的6.5倍变化.
- 与FTR率最低的医院相比,FTR率最高的医院在没有手术并发症的患者中死亡率增加了33%.
- 这种关联甚至在分析复杂慢性疾病患者和新生儿的亚组时也存在.
结论:
- 拯救失败 (FTR) 作为儿科手术的有效质量衡量标准,不仅仅是患有并发症的患者.
- 在高性能医院实施的减少FTR的做法也可能降低没有手术并发症的儿童手术后死亡的风险.
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