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紧急整体手术后未能进行救援:国家分析
Jeffrey Balian1, Nam Yong Cho1, Amulya Vadlakonda1
1Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles, Los Angeles, CA, USA.
Surgery open science
|July 8, 2024
概括
在紧急一般外科手术 (EGS) 中,未能救援 (FTR) 与保险状况和收入有关. 医疗补助和较低收入增加了FTR几率,突出了手术后患者结果的差异.
科学领域:
- 手术质量和患者的结果.
- 医疗保健服务研究 医疗服务研究
- 健康差异 在健康上的差异
背景情况:
- 救援失败 (FTR) 是医疗保健中的关键质量指标,但在紧急整体手术 (EGS) 中还没有得到充分研究.
- 识别与FTR相关的因素对于开发标准化指标以防止不良结果至关重要.
研究的目的:
- 在EGS中确定与FTR相关的患者和操作因素.
- 为制定标准化指标提供信息,以减轻FTR.
主要方法:
- 分析2016-2020年国家再接收数据库的成年人,非选择性的EGS程序.
- 在入院后2天内排除与创伤相关的手术和手术.
- 定义FTR是主要的外科手术后并发症 (需要透析的AKI,心脏病发作,肺炎,呼吸衰竭,败血症,中风,血栓塞栓症) 后的住院死亡.
- 利用多层混合效应模型来识别与FTR相关的因素.
主要成果:
- 在826,548个EGS操作中,有36.1%经历了至少一个重大不良事件 (MAE),其中14.6%导致了FTR.
- 中心水平差异仅占FTR变异的3.5%.
- 与私人保险和最高收入四分之一相比,医疗补助保险 (AOR 1.33) 和最低收入四分之一 (AOR 1.22) 与FTR的几率增加有关.
- 医疗补助和无保险状态显示,在败血症,肺炎和急性损伤 (AKI) 后,FTR几率更高.
结论:
- 调查结果强调了FTR在保险状况和收入方面的显著差异.
- 在EGS的术后并发症发生后,需要加强查和警,以减轻这些差异.
- 解决社会经济因素对于改善高风险EGS患者的治疗结果至关重要.
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