练习让人变得完美吗? 练习让人变得完美 机构冠状动脉绕道术病例数量和结果
Thomas A Schwann1, Milo Engoren2, Mario F Gaudino3
1University of Massachusetts-Baystate, Springfield, MA, USA.
概括
冠状动脉旁路移植 (CABG) 结果随着医院病例数量的增加而改善. 即使是微弱的相关性也表明,如果CABG程序集中在大量的中心,可能会减少死亡率和并发症.
科学领域:
- 心血管外科心血管外科
- 医疗保健服务研究 医疗服务研究
- 提高质量 提高质量
背景情况:
- 关于冠状动脉旁路移植 (CABG) 机构病例数量与患者结果之间的关联,存在相互矛盾的结果.
- 当代手术实践和结果需要更新分析,特别是考虑到心脏手术的进步.
研究的目的:
- 调查当前美国手术实践中孤立初级CABG的机构病例数量和结果之间的关系.
- 评估医院病例数量对手术死亡率 (OM),死亡率/主要发病率 (MM) 和深胸部伤口感染 (DSWI) 的影响.
主要方法:
- 来自胸腔外科医生协会 (STS) 成人心脏手术数据库的2018-2019年孤立初级CABG数据的分析.
- 使用通用估计方程来建模机构CABG体积和结果之间的关联.
- 根据STS风险模型评估风险调整后的结果 (OM,MM,DSWI) 与机构体积相对应的员工观察到的预期比率.
主要成果:
- 总共分析了来自1014家医院的241,902个孤立的初级CABG病例.
- 在机构病例数量和手术死亡率 (R2 -0.0272),死亡率/重大发病率 (R2 -0.1213) 和深胸部伤口感染 (R2 -0.003) 之间观察到微弱的负相关性.
- 处理不到100例病例的机构占总数的23%,而9%的机构在每个研究期内处理超过500例病例.
结论:
- 冠状动脉绕道移植的结果显示,随着机构病例数量的增加,整体改善趋势.
- 将CABG手术集中在体积较高的机构可以在全国范围内显著减少手术死亡率,主要发病率和深胸部伤口感染.
- 建议对其他医院和外科医生特定因素进行进一步的研究,以确定CABG护理的进一步质量改进机会.
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