Variation in Outcomes for Benchmark Operations: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database DISCUSSION
Variation in Outcomes for Benchmark Operations: An Analysis of The Society of Thoracic Surgeons Congenital Heart Surgery Database DISCUSSION
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DOI：
10.1016/j.athoracsur.2011.06.008
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发表时间：
2011-12-01
影响因子：
4.6
通讯作者：
Mavroudis, Constantine
中科院分区：
文献类型：
--
作者：
Jacobs, Jeffrey Phillip;O'Brien, Sean M.;Mavroudis, Constantine
背景。我们评估了胸外科学会先天性心脏手术数据库（STS-CHSDB）中常见手术的结果，以提供当代基准并检查各中心之间的差异。包括2005年至2009年接受手术的患者。数据缺失量大于10%的中心被排除。计算8种不同复杂程度的基准手术中存活出院患者的出院死亡率和术后住院时间（PLOS）。对每次手术结果的中心间差异进行分析。使用漏斗图和贝叶斯分层模型评估变异。在对8个基准操作的分析中，包括74个中心的18375个指数操作。整体放电死亡率:室间隔缺损(VSD)修复= 0.6%(范围,0%到5.1%),法洛四联症(TOF)修复= 1.1%(范围,0%到16.7%),完全房室管修复(AVC) = 2.2%(范围,0%到20%),动脉开关操作(麻生太郎)= 2.9%(范围,0%到50%),麻生太郎+ VSD = 7.0%(范围,0%到100%),Fontan操作= 1.3%(范围,0%到9.1%),动脉干修复= 10.9%(0%对100%),和诺伍德过程= 19.3%(范围,0%到100%)。漏斗图显示异常中心数为VSD = 0, TOF = 0, AVC = 1, ASO = 3, ASO + VSD = 1， Fontan手术= 0，动脉干修复= 4，Norwood手术= 11。幂次计算显示，各中心之间的死亡率比较只有在诺伍德手术中才有统计学意义，风险调整后的贝叶斯估计范围（95%概率区间）为7.0%(3.7% ~ 10.3%)~ 41.6%（30.6% ~ 57.2%）。对所有手术的PLOS中心间差异进行分析，对于更复杂的手术，PLOS中心间差异更大。本分析记录了当代儿科常见心脏外科手术的基准和各中心的结果范围。对于较为复杂的操作，变异最为突出。这些数据可能有助于质量评估和质量改进计划。（Ann Thorac surgery, 2011;92:2184-92） (C) 2011年由胸外科学会出版
Background. We evaluated outcomes for common operations in The Society of Thoracic Surgeons Congenital Heart Surgery Database (STS-CHSDB) to provide contemporary benchmarks and examine variation between centers.Methods. Patients undergoing surgery from 2005 to 2009 were included. Centers with greater than 10% missing data were excluded. Discharge mortality and postoperative length of stay (PLOS) among patients discharged alive were calculated for 8 benchmark operations of varying complexity. Power for analyzing between-center variation in outcome was determined for each operation. Variation was evaluated using funnel plots and Bayesian hierarchical modeling.Results. Eighteen thousand three hundred seventy-five index operations at 74 centers were included in the analysis of 8 benchmark operations. Overall discharge mortality was: ventricular septal defect (VSD) repair = 0.6% (range, 0% to 5.1%), tetralogy of Fallot (TOF) repair = 1.1% (range, 0% to 16.7%), complete atrioventricular canal repair (AVC) = 2.2% (range, 0% to 20%), arterial switch operation (ASO) = 2.9% (range, 0% to 50%), ASO + VSD = 7.0% (range, 0% to 100%), Fontan operation = 1.3% (range, 0% to 9.1%), truncus arteriosus repair = 10.9% (0% to 100%), and Norwood procedure = 19.3% (range, 0% to 100%). Funnel plots revealed that the number of centers characterized as outliers were VSD = 0, TOF = 0, AVC = 1, ASO = 3, ASO + VSD = 1, Fontan operation = 0, truncus arteriosus repair = 4, and Norwood procedure = 11. Power calculations showed that statistically meaningful comparisons of mortality rates between centers could be made only for the Norwood procedure, for which the Bayesian-estimated range (95% probability interval) after risk-adjustment was 7.0% (3.7% to 10.3%) to 41.6% (30.6% to 57.2%). Between-center variation in PLOS was analyzed for all operations and was larger for more complex operations.Conclusions. This analysis documents contemporary benchmarks for common pediatric cardiac surgical operations and the range of outcomes among centers. Variation was most prominent for the more complex operations. These data may aid in quality assessment and quality improvement initiatives. (Ann Thorac Surg 2011;92:2184-92) (C) 2011 by The Society of Thoracic Surgeons