大型手术后未能救援的医院间变化
David Schwappach1, Marcel Zwahlen1, Michael M Havranek2
1Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland.
JAMA network open
|February 4, 2026
概括
近五分之一的患有并发症的手术患者死亡,这突出了医院在救援失败 (FTR) 率的显著变化. 机构的表现占了1000多起可能可避免的死亡,强调了FTR作为患者安全的关键指标.
科学领域:
- 医疗保健的质量和安全
- 外科手术患者的结果
- 医疗保健服务研究 医疗服务研究
背景情况:
- 被定义为可治疗并发症后的术后死亡率的救助失败 (FTR) 是一个关键的患者安全问题.
- FTR反映了管理患者病情恶化的机构能力,并被提出作为质量指标.
- 在美国以外,关于FTR在医院水平上的系统变异的证据有限.
研究的目的:
- 为了估计瑞士的全国术后FTR率.
- 量化医院间FTR的变化.
- 通过使用风险标准化死亡率 (RSMRs) 来确定表现比预期好或差的医院.
主要方法:
- 使用瑞士 (2019-2023) 的行政医院数据进行回顾性队列研究.
- 应用医疗保健研究和质量机构 (AHRQ) 患者安全指标04 (PSI04) 定义对具有特定并发症的外科住院患者.
- 利用多层次物流回归和RSMR来评估医院一级的变化和性能.
主要成果:
- 全国FTR总比率为18.07%.
- 在各医院观察到死亡率的显著变化,调整后的几率比率从0.56到1.75.5不等.
- 据估计,机构的表现导致了1045例可能可以避免的死亡,其中23%的医院表现比预期差.
结论:
- 在手术并发症后的失败救援率中存在实质性的医院间变化.
- 机构的表现对患者的结果产生重大影响,大量的死亡可能是可以避免的.
- FTR作为一种有价值的国际患者安全指标,需要对推动绩效变化的组织因素进行调查.
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