Is the Impact of Hospital and Surgeon Volumes on the In-Hospital Mortality Rate for Coronary Artery Bypass Graft Surgery Limited to Patients at High Risk?
Is the Impact of Hospital and Surgeon Volumes on the In-Hospital Mortality Rate for Coronary Artery Bypass Graft Surgery Limited to Patients at High Risk?
复制标题
医院和外科医生数量对冠状动脉搭桥移植手术院内死亡率的影响是否仅限于高风险患者？
DOI：
10.1161/01.cir.0000138744.13516.b5
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发表时间：
2004
期刊：
影响因子：
37.8
通讯作者：
V. Subramanian
中科院分区：
文献类型：
--
作者：
Chuntao Wu;E. Hannan;T. Ryan;E. Bennett;A. Culliford;J. Gold;O. Isom;Robert H. Jones;B. Mcneil;E. Rose;V. Subramanian
背景：有人建议限制对高危患者进行冠状动脉搭桥手术的容积转诊，而早期的研究对低危患者的容积转诊得出了不同的结论。方法和结果：1997年至1999年在纽约接受孤立性冠脉搭桥手术的患者（n= 57150）被分为低风险组和中至高危组，预测住院死亡概率为2%。对两组的供给者数量-死亡率关系进行了检查。对于200 - 600例的年度医院容量阈值，大容量到小容量医院的住院死亡率调整ORs范围为0.45 - 0.77，在低风险组均显著；中高危组的or值为0.62 ~ 0.91，且多数显著。低风险组为避免1例死亡而需要在规模较大的医院接受治疗的人数更多（114至446人对37至184人）。随着年手术量阈值从50例增加到150例，低风险组高、低手术量的or从0.43增加到0.74；中高危组的or值为0.79 ~ 0.86。与在规模小于600的医院接受规模<125的外科医生治疗的患者相比，在规模较大的医院接受规模较大的外科医生治疗的患者死亡风险显著降低；特别是，低风险组的OR为0.52。结论：对于低风险和中至高风险患者，较高的提供者数量与较低的死亡风险相关。
Background—Restriction of volume-based referral for CABG surgery to high-risk patients has been suggested, and earlier studies have reached different conclusions regarding volume-based referral for low-risk patients. Methods and Results—Patients who underwent isolated CABG surgery in New York from 1997 through 1999 (n=57 150) were separated into low-risk and moderate-to-high-risk groups with a predicted probability of in-hospital death of 2% as the cutoff point. The provider volume-mortality relationship was examined for both groups. For annual hospital volume thresholds between 200 and 600 cases, the adjusted ORs of in-hospital mortality for high-volume to low-volume hospitals ranged from 0.45 to 0.77 and were all significant for the low-risk group; for the moderate-to-high-risk group, ORs ranged from 0.62 to 0.91, and most were significant. The number needed to treat at higher-volume hospitals to avoid 1 death was greater for the low-risk group (a range of 114 to 446 versus 37 to 184). As the annual surgeon volume threshold increased from 50 to 150 cases, the ORs for high- to low-volume surgeons increased from 0.43 to 0.74 for the low-risk group; for the moderate-to-high-risk group, ORs ranged from 0.79 to 0.86. Compared with patients treated by surgeons with volumes of <125 in hospitals with volumes of <600, patients treated by higher-volume surgeons in higher-volume hospitals had a significantly lower risk of death; in particular, the OR was 0.52 for the low-risk group. Conclusions—For both low-risk and moderate-to-high-risk patients, higher provider volume is associated with lower risk of death.
影响因子：
1.9
作者：
ZEGER, SL;LIANG, KY;ALBERT, PS
通讯作者：
ALBERT, PS