Are high-quality cardiac surgeons less likely to operate on high-risk patients compared to low-quality surgeons? Evidence from New York State.
Are high-quality cardiac surgeons less likely to operate on high-risk patients compared to low-quality surgeons? Evidence from New York State.
复制标题
与低素质的外科医生相比，高素质的心脏外科医生是否不太可能为高风险患者进行手术？
DOI：
10.1111/j.1475-6773.2007.00753.x
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发表时间：
2008
影响因子：
3.4
通讯作者：
Osler,TurnerM
中科院分区：
文献类型：
--
作者：
Glance,LaurentG;Dick,Andrew;Mukamel,DanaB;Li,Yue;Osler,TurnerM
背景：尚不清楚高风险心脏手术患者是否比低风险患者更难获得高质量的外科医生。目的：确定高质量外科医生是否比低质量外科医生更不可能为高风险患者进行冠状动脉旁路移植术（CABG）。设计，设置，使用纽约州（NYS）CABG手术报告系统（CSRS）进行的回顾性队列研究1997年至1999年期间在纽约州接受CABG手术的所有出院患者（51，750例患者; 2.20%死亡率）。回归模型用于估计外科医生质量与患者死亡风险之间的相关性。外科医生质量通过观察到的死亡率与预期死亡率之比（O-to-E ratio）进行量化。结果：高风险患者更有可能接受高质量外科医生的CABG手术。患者死亡风险每增加10个百分点（例如，从5%到15%），外科医生O‐to‐E比率绝对降低了0.034（p< .001）。结论：本研究表明，与低风险患者相比，高风险CABG患者更有可能接受高质量外科医生的护理。
Context.It is unknown whether high‐risk cardiac surgical patients have less access to high‐quality surgeons compared with lower‐risk patients.Objective.To determine whether high‐quality surgeons are less likely to perform coronary artery bypass graft (CABG) surgery on high‐risk patients compared with low‐quality surgeons.Design, Setting, and Patients.Retrospective cohort study using the New York State (NYS) CABG Surgery Reporting System (CSRS) of all patients undergoing CABG surgery in NYS who were discharged between 1997 and 1999 (51,750 patients; 2.20 percent mortality). Regression modeling was used to estimate the association between surgeon quality and patient risk of death. Surgeon quality was quantified using the observed‐to‐expected mortality ratio (O‐to‐E ratio).Results.Higher‐risk patients are more likely to receive CABG surgery from higher‐quality surgeons. For every 10 percentage point increase in patient risk of death (e.g., from 5 to 15 percent), there is an absolute reduction of 0.034 in the surgeon O‐to‐E ratio (p< .001).Conclusion.This study suggests that high‐risk CABG patients are significantly more likely to receive care from high‐quality surgeons compared with lower risk patients.