A REGIONAL PROSPECTIVE-STUDY OF IN-HOSPITAL MORTALITY ASSOCIATED WITH CORONARY-ARTERY BYPASS-GRAFTING
A REGIONAL PROSPECTIVE-STUDY OF IN-HOSPITAL MORTALITY ASSOCIATED WITH CORONARY-ARTERY BYPASS-GRAFTING
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DOI：
10.1001/jama.266.6.803
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发表时间：
1991-08-14
影响因子：
120.7
通讯作者：
WENNBERG, JE
中科院分区：
文献类型：
--
作者：
OCONNOR, GT;PLUME, SK;WENNBERG, JE
目的：进行一项前瞻性区域研究，以确定观察到的与冠状动脉旁路移植术 (CABG) 相关的院内死亡率差异是否仅仅是患者病例组合差异的结果。设计：区域前瞻性队列研究收集的数据包括患者人口统计和历史数据、体表面积、心导管插入术结果、手术优先顺序、合并症和出院状态。这项研究提供了 1987 年 7 月 1 日至 1989 年 4 月 15 日期间 3055 名 CABG 患者的数据。背景。-这项研究包括来自缅因州、新罕布什尔州和佛蒙特州所有进行心胸外科手术的外科医生的数据；数据收集自五个地区医疗中心。患者。-数据收集自研究期间所有连续的孤立性 CABG 手术患者。主要结果指标。-与 CABG 相关的粗略和调整后的院内死亡率。主要结果。-孤立性 CABG 的总体粗略院内死亡率为 4.3%。该比率因中心（范围为 3.1% 至 6.3%）和外科医生（范围为 1.9% 至 9.2%）而异。院内死亡率的预测因素包括年龄增加、女性、体表面积较小、合并症较多、再次手术、射血分数较低所表明的心功能较差、左心室舒张末压增加以及紧急或紧急手术。在调整潜在混杂变量的影响后，在医疗中心 (P = .021) 和外科医生 (P = .025) 之间观察到显着且具有统计显着性的差异。结论。-我们得出的结论是，新英格兰北部各机构和外科医生之间观察到的院内死亡率差异不仅仅是这些变量所描述的病例组合差异的结果，而且可能反映了目前未知的差异 患者护理的各个方面。了解这种变化需要详细了解护理过程。
Objective.-A prospective regional study was conducted to determine if the observed differences in in-hospital mortality rates associated with coronary artery bypass grafting (CABG) are solely the result of differences in patient case mix.Design.-Regional prospective cohort study Data including patient demographic and historical data, body surface area, cardiac catheterization results, priority of surgery, comorbidity, and status at hospital discharge were collected. This study presents data for 3055 CABG patients between July 1, 1987, and April 15, 1989.Setting.-This study includes data from all surgeons performing cardiothoracic surgery in Maine, New Hampshire, and Vermont; the data were collected from five regional medical centers.Patients.-Data were collected from all consecutive isolated CABG surgery patients during the study period.Main Outcome Measures.-Crude and adjusted in-hospital mortality rates associated with CABG.Main Results.-The overall crude in-hospital mortality rate for isolated CABG was 4.3%. The rate varied among centers (range, 3.1% to 6.3%) and among surgeons (range, 1.9% to 9.2%). Predictors of in-hospital mortality included increased age, female gender, small body surface area, greater comorbidity, reoperation, poorer cardiac function as indicated by a lower ejection fraction, increased left ventricular end diastolic pressure, and emergent or urgent surgery. After adjusting for the effects of potentially confounding variables, substantial and statistically significant variability was observed among medical centers (P = .021) and among surgeons (P = .025).Conclusion.-We conclude that the observed differences in in-hospital mortality rates among institutions and among surgeons in northern New England are not solely the result of differences in case mix as described by these variables and may reflect differences in currently unknown aspects of patient care. Understanding this variation requires a detailed understanding of the processes of care.