一个以患者为中心的教科书结果措施有效地歧视当代的选择性开放腹部大动脉动脉瘤修复质量
Amy Felsted1, Adam W Beck2, Charles Adam Banks2
1Section of Vascular Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
Journal of vascular surgery
|June 5, 2024
概括
开放腹腔大动脉瘤 (AAA) 修复的教科书结局 (TOs) 提供了一个以患者为中心的质量衡量标准. 虽然更高的外科手术量与更好的TOs相关,但全国不到一半的AAA修复符合这一综合结果.
科学领域:
- 血管外科 血管外科
- 改善外科手术的质量
- 患者为中心的结果.
背景情况:
- 开放腹部大动脉动脉瘤 (AAA) 修复质量的外科体积基准缺乏细微差别.
- 量配额可能无法捕捉患者相关的外科治疗结果.
- 建议以患者为中心的教科书结果 (TO) 来评估AAA修复质量.
研究的目的:
- 提出和测试一个以患者为中心的教科书结局 (TO) 开放腹腔大动脉瘤 (AAA) 修复.
- 评估TOs在区分医院绩效方面的可行性.
- 根据血管外科学会 (SVS) 量指南,比较TO的成绩.
主要方法:
- 从SVS-血管质量倡议 (2009-2022) 中对可选的开放性下AAA修复 (OAR) 的分析.
- 定义TO为没有住院并发症/重新干预的组合,停留时间≤10天,出院,以及1年的生存率.
- 通过使用后勤和多变量回归,比较了满足 (≥10个OAR/年) 和不满足 (<10个OAR/年) SVS体积建议的中心之间的TO率.
主要成果:
- 总共分析了198个中心的9,657个OAR.
- 在整体队列中,有44%的人实现了ATO.
- 高体积中心 (≥10个OAR/年) 显示,与低体积中心 (42%;P=.0006) 相比,TO实现的可能性更高 (46%),即使经过风险调整 (OR,1.1;P=.003).
结论:
- 教科书结局 (TOs) 提供了一个更细致的,以患者为中心的衡量开放腹腔大动脉瘤 (AAA) 修复质量的标准.
- 在全国范围内,不到50%的可选AAA维修实现了TO.
- 虽然与血管外科协会 (SVS) 的体积建议相关,但TOs为改善现实世界AAA护理提供了关键的见解.
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