The society of thoracic surgeons: 30-day operative mortality and morbidity risk models
The society of thoracic surgeons: 30-day operative mortality and morbidity risk models
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DOI：
10.1016/s0003-4975(03)00179-6
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发表时间：
2003-06-01
影响因子：
4.6
通讯作者：
Edwards, FH
中科院分区：
文献类型：
--
作者：
Shroyer, ALW;Coombs, LP;Edwards, FH
背景虽然30天风险调整手术死亡率（ROM）已被用于质量评估，但它不足以描述冠状动脉旁路移植术（CABG）手术后的结局。风险调整后的主要发病率可能会对护理质量产生不同的影响（因为并发症的发生频率高于死亡），并提高手术团队评估其质量的能力。本研究确定了与几种并发症和复合结局（存在任何重大并发症或30天手术死亡率或两者）相关的术前风险因素。对于CABG手术，使用1997年至1999年胸外科医师协会（STS）国家成人心脏手术数据库开发ROM和风险调整后发病率（ROMB）模型。使用标准STS单变量筛选和多变量logistic回归方法选择危险因素。评估了风险模型性能。在STS参与的临床试验机构中，对ROM和ROMB的预期与预期（O/E）比值的相关性进行了评价。STS CABG手术的30天手术死亡率和重大并发症发生率分别为3.05%和13.40%（503，478例CABG手术），包括卒中（1.63%）、肾衰竭（3.53%）、再次手术（5.17%）、通气时间延长（5.96%）和胸骨感染（0.63%）。开发了风险模型（卒中[0.72]、肾衰竭[0.76]、再次手术[0.64]、延长通气[0.75]、胸骨感染[0.66]和复合终点[0.71]的c指数）。然而，在ROMB和ROM指标之间仅发现轻微的相关性。结合使用，ROMB和ROM可以为手术团队提供额外的信息，以评估他们的护理质量，以及有价值的见解，使他们能够专注于改进的领域。(C)2003年由胸外科医师协会发布。
Background. Although 30day risk-adjusted operative mortality (ROM) has been used for quality assessment, it is not sufficient to describe the outcomes after coronary artery bypass grafting (CABG) surgery. Risk-adjusted major morbidity may differentially impact quality of care (as complications occur more frequently than death) and enhance a surgical team's ability to assess their quality. This study identified the preoperative risk factors associated with several complications and a composite outcome (the presence of any major morbidity or 30-day operative mortality or both).Methods. For CABG procedures, the 1997 to 1999 Society of Thoracic Surgeons (STS) National Adult Cardiac Surgery Database was used to develop ROM and risk-adjusted morbidity (ROMB) models. Risk factors were selected using standard STS univariate screening and multivariate logistic regression approaches. Risk model performance was assessed. Across STS participating sites, the association of observed-to-expected (O/E) ratios for ROM and ROMB was evaluated.Results. The 30-day operative death and major complication rates for STS CABG procedures were 3.05% and 13.40%, respectively (503,478 CABG procedures), including stroke (1.63%), renal failure (3.53%), reoperation (5.17%), prolonged ventilation (5.96%), and sternal infection (0.63%). Risk models were developed (c-indexes for stroke [0.72], renal failure [0.76], reoperation [0.64], prolonged ventilation [0.75], sternal infection [0.66], and the composite endpoint [0.71]). Only a slight correlation was found, however, between ROMB and ROM indicators.Conclusions. Used in combination, ROMB and ROM may provide the surgical team with additional information to evaluate the quality of their care as well as valuable insights to allow them to focus on areas for improvement. (C) 2003 by The Society of Thoracic Surgeons.