预测心脏手术后血管压缩剂的使用在一个大型的多中心国家心脏手术数据库中
Enya Martic1, Mohammad Asghari-Jafarabadi2, Jenni Williams-Spence3
1Department of Anaesthesiology and Perioperative Medicine, The Alfred Hospital, Melbourne, Australia; Department of Anaesthesiology and Perioperative Medicine, Monash University, Melbourne, Australia.
Journal of cardiothoracic and vascular anesthesia
|September 24, 2025
概括
预测心脏手术后的血管压缩剂使用是很困难的,仅仅使用患者因素. 医院存在显著的差异,包括医院数据可以提高预测的准确性.
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
- 医疗信息学 医疗信息学
背景情况:
- 心脏手术后使用血管压缩剂是常见的.
- 预测其需求和了解实践变化对于质量改进至关重要.
研究的目的:
- 开发心脏手术后血管压缩剂的预测模型.
- 量化和描述血管压缩剂使用的机构间变化.
主要方法:
- 对106,348名接受心脏手术的患者 (2012-2021) 的回顾性多机构分析.
- 使用术前和术后变量开发预测模型.
- 采用了最小绝对收缩和选择操作员 (LASSO) 回归和混合效应多层建模.
主要成果:
- 血管压缩剂的发病率为29.3%,具有显著的医院间变异性 (1.2%至69.4%).
- 仅使用患者和外科变量的模型显示预测准确度差至相当 (AUC为0.56-0.60).
- 纳入医院级因素大大提高了预测准确度 (AUC 0.75-0.76).
结论:
- 仅仅患者和手术因素就为心脏手术后的血管压缩剂使用提供了有限的预测能力.
- 血管压缩剂的使用率存在显著的,无法解释的机构差异.
- 考虑到医院特定的因素对于准确的预测和理解实践模式至关重要.
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