The appropriateness of use of coronary artery bypass graft surgery in New York State.

The appropriateness of use of coronary artery bypass graft surgery in New York State.
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纽约州使用冠状动脉搭桥手术的适当性。

DOI：
10.1001/jama.1993.03500060053030
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发表时间：
1993
期刊：
JAMA
影响因子：
--
通讯作者：
R. Brook
R. Brook
中科院分区：
--
文献类型：
--
作者：
L. Leape;L. Hilborne;R. Park;S. Bernstein;C. Kamberg;M. Sherwood;R. Brook

文献摘要

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目的 确定在纽约州使用冠状动脉旁路移植术的适当性。 设计 回顾性随机病历审查。 设置 在纽约州随机选择的15家提供冠状动脉旁路移植手术的医院。 患者 随机抽取1990年纽约州行隔离冠状动脉旁路移植术的1338例患者。 主要观察指标 因适当、不适当或不确定适应症而接受旁路手术的患者百分比;手术（30天）死亡率;并发症。 结果 近91%的旁路手术被评为适当; 7%，不确定; 2.4%，不适当。这一较低的不适当率与1979年、1980年和1982年对手术患者进行的先前研究中发现的14%的不适当率有很大不同。比率的差异不是由于更宽松的标准，而是由于实践的变化，最重要的是接受冠状动脉旁路移植术的患者比例从51%下降到24%。个别医院的不适当率（0%至5%）没有显着差异。适当率也没有因医院的位置、数量或教学状况而变化。手术死亡率为2.0%; 17%的患者出现并发症。不同医院的并发症发生率差异显著（P <0.01），南部医院的并发症发生率更高。 结论 纽约州冠状动脉旁路移植术的不适当和不确定使用率非常低。不适当使用率在不同医院、不同地区、不同搭桥手术量或不同教学状况之间没有显著差异。
OBJECTIVE To determine the appropriateness of use of coronary artery bypass graft surgery in New York State. DESIGN Retrospective randomized medical record review. SETTING Fifteen randomly selected hospitals in New York State that provide coronary artery bypass graft surgery. PATIENTS Random sample of 1338 patients undergoing isolated coronary artery bypass graft surgery in New York State in 1990. MAIN OUTCOME MEASURES Percentage of patients who had bypass surgery for appropriate, inappropriate, or uncertain indications; operative (30-day) mortality; and complications. RESULTS Nearly 91% of the bypass operations were rated appropriate; 7%, uncertain; and 2.4%, inappropriate. This low inappropriate rate differs substantially from the 14% rate found in a previous study of patients operated on in 1979, 1980, and 1982. The difference in rates was not due to more lenient criteria but to changes in practice, the most important being that the fraction of patients receiving coronary artery bypass grafts for one- and two-vessel disease fell from 51% to 24%. Individual hospital rates of inappropriateness (0% to 5%) did not vary significantly. Rates of appropriateness also did not vary by hospital location, volume, or teaching status. Operative mortality was 2.0%; 17% of patients suffered a complication. Complication rates varied significantly among hospitals (P < .01) and were higher in downstate hospitals. CONCLUSIONS The rates of inappropriate and uncertain use of coronary artery bypass graft surgery in New York State were very low. Rates of inappropriate use did not vary significantly among hospitals, or according to region, volume of bypass operations performed, or teaching status.