仅凭体积并不能预测小儿心脏外科手术的医院的质量结果
Dhaval Chauhan1, J Hunter Mehaffey1, J W Awori Hayanga1
1Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia.
The Annals of thoracic surgery
|January 30, 2024
概括
仅仅儿童心脏手术的体积并不能预测结果. 存在高性能低体积中心,挑战了假设更多病例等同于更好的儿科心脏手术质量.
科学领域:
- 儿科心脏手术 儿科心脏手术
- 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:
- 较低的机构体积往往与更糟糕的儿科心脏手术结果有关.
- 这项研究调查了儿童心脏手术不同医院体积的死亡率变化.
研究的目的:
- 分析儿童心脏外科手术中医院体积和风险调整后死亡率之间的关系.
- 确定医院体积是否是小儿心脏手术质量的可靠预测指标.
主要方法:
- 使用了儿童住院患者数据库 (2016年,2019年).
- 不包括只进行特定手术的医院 (绕道外缩,VSD修复).
- 将医院分为低,中,高体积组,并使用后勤回归来进行风险调整后的死亡率分析.
主要成果:
- 分析了来自235家医院的25749例儿科心脏手术.
- 整体风险调整后的死亡率为1.9%.
- 在基准程序的低,中,高体积中心中,没有发现风险调整后死亡率的显著差异.
结论:
- 仅仅是医院的体积可能不是儿童心脏手术质量的唯一指标.
- 仅仅依赖案例数量可能会不准确地评估高业绩的低量程序的表现.
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