高质量的CLTI护理需要在外科绕道和内血管治疗中表现高于平均水平
Douglas W Jones1, Richard J Powell2, Salvatore T Scali3
1Division of Vascular and Endovascular Surgery, University of Massachusetts Chan Medical School, Worcester, MA.
Journal of vascular surgery
|February 5, 2026
概括
慢性四肢威胁性缺血症 (CLTI) 护理的高性能中心在外科绕道和内血管治疗方面都表现出色. 熟练掌握这两种方法是最佳患者结果的关键,正如新型质量指标所证明的那样.
科学领域:
- 血管外科 血管外科
- 干预心脏病学 干预心脏病学
- 医疗保健服务研究 医疗服务研究
背景情况:
- 慢性四肢威胁性缺血症患者的BEST内血管与外科治疗 (BEST-CLI) 试验比较了手术绕道和内血管治疗的CLTI.
- 血管外科手术结果的中心水平变化是已知的,但它在BEST-CLI中的影响和传统质量指标的有效性未得到充分探索.
- 这项研究引入了新的基于概率的质量指标 (获得的结果[EO]和胜率高于平均水平[WAA]) 来评估中心在CLTI治疗中的表现.
研究的目的:
- 通过使用新型质量指标,评估CLTI外科绕道和内血管治疗的中心水平表现.
- 为了研究这两个治疗模式的高性能导致最佳的整体患者结果的假设.
主要方法:
- 参与的BEST-CLI中心使用组合主要不良肢体事件 (MALE) 或所有接受治疗的患者的死亡率进行了评估.
- 胜利高于平均水平 (WAA) 计算为风险调整后的,对数量敏感的指标,根据使用EO方法的MALE/死亡得出.
- 根据WAA,中心被分为四分之一,患者人口统计和结果在四分之一之间进行了比较. 这些中心还根据WAA表现 (高于/低于平均水平) 来分类绕道,内血管治疗或两者兼而有之.
主要成果:
- 分析包括146个中心的1440名患者,两年MALE/死亡率因WAA四分位数 (Q1: 58%至Q4: 30%) 显著变化.
- 在WAA方面,中心分布均:在两种模式中均高于平均水平的27%,仅在绕道方面为27%,仅在内血管方面为21%,在两种模式中均低于平均水平的25%.
- 在这两种模式中,表现最好的中心 (第四季度) 主要实现了高于平均水平的结果 (84%),而底部中心 (第一季度) 在这两种模式中经常低于平均水平 (62%). 只有在一种模式中表现出色的中心不太可能成为表现最佳的中心.
结论:
- 在BEST-CLI中心中,MALE/死亡率存在显著差异,在2年内,最低和最高表现的四分位数之间的差异约为30%.
- 性能最好的中心在手术绕道和内血管治疗中都表现出一致的平均以上的结果.
- 最佳的CLTI护理需要熟练掌握两种治疗方式,强调需要先进的质量指标来区分中心的性能.
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