增加的市场竞争与复杂的大动脉手术后的死亡率降低有关
Zach M Feldman1, Gregory Leya2, Andrew Oseran3
1Division of Vascular and Endovascular Surgery, Massachusetts General Hospital, Boston, MA.
Journal of vascular surgery
|April 30, 2025
概括
当地市场的竞争加剧与复杂的大动脉手术患者的短期生存率提高有关. 然而,在不同的市场竞争水平上,长期生存率仍然相似. 需要进一步的研究来理解和改善护理准入.
科学领域:
- 血管外科 血管外科
- 医疗保健服务研究 医疗服务研究
- 外科手术的结果
背景情况:
- 在竞争激烈的市场中,集中式的大动脉中心可能会产生更糟糕的结果.
- 当地市场竞争对复杂的大动脉手术的影响尚不清楚.
研究的目的:
- 评估当地市场竞争如何影响复杂的大动脉手术的结果.
- 分析市场竞争与30天死亡率和长期存活率之间的关联.
主要方法:
- 从血管质量倡议 (VQI) (2013-2022) 中对10,868名患者的回顾性审查.
- 根据赫芬达尔-希尔施曼指数 (HHI) 定义的市场竞争;较高的HHI表明竞争较低.
- 使用多变量后勤和Cox生存模型;灵敏度分析包括血管植入物监测和干预结果网络 (VIISON).
主要成果:
- 在高竞争地区 (23.7%) 与中等 (25.9%) 和低 (25.9%) 竞争相比,观察到较低的30天死亡率.
- 中等区域竞争与较高竞争相比,增加了30天死亡率 (OR,1.39).
- 敏感性分析显示了类似的趋势,但在竞争水平之间没有发现长期死亡率的显著差异.
结论:
- 更具竞争力的地区在复杂的大动脉手术后的30天死亡率较低.
- 无论市场竞争如何,长期生存率都是相同的.
- 努力应集中于了解改善短期结果的驱动因素,以提高获得高质量的护理的机会.
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