Out-of-Hospital 30-day Deaths After Cardiac Surgery Are Often Underreported
Out-of-Hospital 30-day Deaths After Cardiac Surgery Are Often Underreported
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DOI：
10.1016/j.athoracsur.2019.09.061
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发表时间：
2020-07-01
影响因子：
4.6
通讯作者：
Kurlansky, Paul A.
中科院分区：
文献类型：
--
作者：
Hannan, Edward L.;Samadashvili, Zaza;Kurlansky, Paul A.
背景手术死亡率（首次住院期间或出院后手术后30天内）通常用作公开报告心脏手术结局的护理质量指标，但准确获取院外死亡的能力仍不确定。本研究的目的是评估院外死亡报告不完整对医院风险调整死亡率和离群值状态的影响。方法.使用纽约州2014年至2016年的心脏登记数据，比较了所有54，442例接受隔离冠状动脉旁路移植术、心脏瓣膜手术或两者的患者在使用和不使用国家和州一级生命统计数据的情况下出院后30天死亡的采集情况。基于使用和不使用生命统计数据开发的统计模型，比较医院风险调整的手术死亡率和死亡率离群值。结果在心脏外科手术中，出院后30天的术后死亡占所有手术死亡的10%至39%。超过30%的死亡病例缺失，10例心脏手术中有7例未确认生命统计数据，超过40%的死亡病例缺失5例。当使用生命统计数据证实出院后30天的术后死亡时，发现瓣膜手术的额外高离群值。结论.心脏手术后的手术死亡率通常被低估，因为报告中心遗漏了相当大比例的院外心脏手术死亡。这可能会对公共报告中医院风险调整死亡率的评估产生不利影响。(Ann Thorac Surg 2020;110：183-8）（C）2020，胸外科医师协会
Background. Operative mortality (in-hospital during the index admission or within 30 days of the procedure after discharge) is commonly used as a quality of care measure for public reporting of cardiac surgery outcomes, but the ability to capture out-of-hospital deaths accu- rately remains undetermined. The objective of the study was to estimate the impact of incomplete reporting of out- of-hospital deaths on hospital risk-adjusted mortality and outlier status. Methods. New York State's 2014 to 2016 cardiac regis- try data were used to compare the capture of 30-day postprocedure deaths after discharge with and without the use of national and state-level vital statistics data for all 54,442 patients undergoing isolated coronary artery bypass graft, cardiac valve surgery, or both. Hospital risk- adjusted operative mortality rates and mortality outliers were compared based on statistical models that were developed with and without the use of vital statistics data. Results. Thirty-day deaths postprocedure after discharge ranged from 10% to 39% of all operative deaths among cardiac surgical procedures. More than 30% of these deaths were missing without vital statistics con firmation for 7 of the 10 cardiac procedures exam- ined, and more than 40% were missing for 5 of the procedures examined. When vital statistics data were used to con firm 30-day postprocedure deaths after discharge, an additional high outlier for valve surgery was identi fied. Conclusions. Operative mortality after cardiac surgery is often underreported owing to a considerable percent- age of out-of-hospital cardiac surgery deaths that are missed by reporting centers. This can adversely affect the assessment of hospital risk-adjusted mortality in public reports. (Ann Thorac Surg 2020;110:183-8) (C) 2020 by The Society of Thoracic Surgeons