医院的特点与心脏外科手术中的救援失败有关
Gabriela O Escalante1, Jocelyn Sun2, Susan Schnell3
1Columbia University Vagelos College of Physicians and Surgeons, New York, NY.
JTCVS open
|January 11, 2024
概括
特定的医院过程,包括心脏训练有素的麻醉师和体外膜氧化可用性,与心脏手术患者的救援失败率降低有关.
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:
- 救援失败 (FTR) 是心脏手术中的一个关键指标,反映了并发症后的死亡率.
- 识别影响FTR的可修改的医院因素对于改善患者的治疗结果至关重要.
- 现有的研究往往忽视了多机构网络中的特定医院流程的影响.
研究的目的:
- 调查医院护理流程与救援失败率之间的关联.
- 在多样化的心脏手术网络中,识别特定的医院特征,以减轻救援失败.
主要方法:
- 胸部外科医生协会对20950名接受重大心脏手术的患者的数据进行分析.
- 无法救援的定义是长期通风,中风,功能衰竭或计划外的重新手术后的手术死亡率.
- 多变量混合效应物流模型根据患者风险和医院特征进行调整.
主要成果:
- 在各医院中,救援失败率差异很大 (中位数为12.5%).
- 四个医院特征与较低的FTR有关:心脏训练有素的麻醉师 (OR 0.41),ECMO可用性 (OR 0.41),ICU病床与重症治疗师的比率 (OR 0.87),以及ICU病床总数 (OR 0.97).
- 在调整了患者相关死亡预测因素后,这些关联仍然显著.
结论:
- 特定的医院过程独立地与心脏手术中救援失败的减少有关.
- 实施策略,例如确保心脏训练有素的麻醉师和ECMO可用性,可以提高患者的安全性和降低死亡率.
- 这些发现突出了多机构心脏手术网络质量改善的机会.
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