Variation in Ventilation Time After Coronary Artery Bypass Grafting: An Analysis From The Society of Thoracic Surgeons Adult Cardiac Surgery Database
Variation in Ventilation Time After Coronary Artery Bypass Grafting: An Analysis From The Society of Thoracic Surgeons Adult Cardiac Surgery Database
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DOI：
10.1016/j.athoracsur.2013.03.059
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发表时间：
2013-09-01
影响因子：
4.6
通讯作者：
Shahian, David M.
中科院分区：
文献类型：
--
作者：
Jacobs, Jeffrey P.;He, Xia;Shahian, David M.
背景资料。术后较短的机械通气时间被认为是质量的标志。这项分析评估了一部分接受单独冠状动脉旁路移植术(CABG)的患者术后呼吸时间的中心水平变化。在2009年和2010年，STS成人心脏外科数据库中的325,129名患者接受了单独的冠状动脉搭桥术。如果患者在进入手术室之前进行了插管，需要超过24小时的呼吸机，或者丢失了关键协变量的数据，则排除在外。最终的研究队列是来自1008个中心的274231名孤立的CABG患者。使用贝叶斯分层模型来评估中心间呼吸时间的差异，并探索中心水平协变量的影响。对病例组合进行了有无调整的分析。调整病例组合后，中心水平分布的第90个百分位数与第10个百分位数的中位呼吸机时间之比为9.0：5.0=1.8(95%可信区间：1.79~1.85)。这一比率说明了中心间差异的规模：高于90%的中心的通风时间至少是低于10%的中心的1.8倍。较小的医院容量、住院医师计划和一些人口普查地区与较长的呼吸机使用时间有关。在调整了病情严重程度后，在接受单独冠状动脉搭桥术的这一亚组患者中，术后呼吸时间存在显著的中心间差异。这一发现为多机构质量改进计划提供了机会，旨在限制呼吸机管理的差异，并为所有患者实现尽可能短的呼吸机时间，从而使临床结果和资源利用都受益。(C)2013年，由胸外科医生学会主办
Background. Short postoperative ventilation times are accepted as a marker of quality. This analysis assesses center level variation in postoperative ventilation time in a subset of patients undergoing isolated coronary artery bypass grafting (CABG).Methods. In 2009 and 2010, 325,129 patients in the STS Adult Cardiac Surgery Database underwent isolated CABG. Patients were excluded if they were intubated before entering the operating room, required ventilation for greater than 24 hours, or had missing data on key covariates. The final study cohort was 274,231 isolated CABG patients from 1,008 centers. Bayesian hierarchical models were used to assess between-center variation in ventilation time and to explore the effect of center-level covariates. Analyses were performed with and without adjusting for case mix.Results. After adjusting for case mix, the ratio of median ventilator time at the 90th percentile of the center-level distribution compared with the tenth percentile was 9.0:5.0 = 1.8 (95% credible interval: 1.79 to 1.85). This ratio illustrates the scale of between-center differences: centers above the 90th percentile have a ventilation time of at least 1.8 times that of centers below the tenth percentile. Smaller hospital volume, presence of a residency program, and some census regions were associated with longer ventilation times.Conclusions. After adjustment for severity of illness, substantial inter-center variation exists in postoperative ventilation time in this subset of patients undergoing isolated CABG. This finding represents an opportunity for multi-institutional quality improvement initiatives designed to limit variations in ventilator management and achieve the shortest possible ventilation times for all patients, thus benefiting both clinical outcomes and resource utilization. (C) 2013 by The Society of Thoracic Surgeons