在高风险新生儿诊断手术后,死亡率和救助失败的医院变化
Steven C Mehl1,2, Jorge I Portuondo1, Yao Tian3,4
1Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas, USA.
Neonatology
|October 16, 2023
概括
在高风险新生儿的儿科医院之间,术后死亡率有很大差异. 较高的死亡率与救援失败 (FTR) 的增加有关,这表明需要改善并发症管理.
科学领域:
- 儿科手术 儿科手术
- 新生儿护理 新生儿护理
- 改善医疗保健质量 改善医疗保健质量
背景情况:
- 术后死亡率不成比例地影响具有特定高风险诊断的新生儿.
- 了解医院级死亡率的变化及其驱动因素对于改善结果至关重要.
研究的目的:
- 调查接受高风险诊断手术的新生儿的医院级死亡率变化.
- 确定这种变化是否与救援失败率 (FTR) 的差异有关.
主要方法:
- 对儿科健康信息系统®数据库 (2012-2020) 的分析.
- 包括48所学术儿科医院的20838名婴儿,这些婴儿因八种高风险新生儿诊断而接受手术.
- 根据可靠性调整的住院患者死亡率对医院进行分层,并使用多变量层次回归来评估死亡率和FTR之间的关联.
主要成果:
- 在调整后的医院死亡率 (4.0%至16.3%) 中观察到显著的变化.
- 与死亡率最低的医院相比,死亡率最高的医院出现救援失败的几率明显更高 (OR 1.97).
- 医院的结构特征,如病例数量和NICU床位,在死亡率组之间没有显著差异.
结论:
- 高风险新生儿手术中的医院级死亡率变化并不能由结构因素解释.
- 救援失败率的差异表明,专注于早期识别和治疗术后并发症的质量改善举措至关重要.
- 有针对性的干预措施可以提高重症新生儿的手术质量和安全性.
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