Mortality data in adult cardiac surgery for named surgeons: retrospective examination of prospectively collected data on coronary artery surgery and aortic valve replacement
Mortality data in adult cardiac surgery for named surgeons: retrospective examination of prospectively collected data on coronary artery surgery and aortic valve replacement
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DOI：
10.1136/bmj.330.7490.506
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发表时间：
2005-03-05
影响因子：
105.7
通讯作者：
Bridgewater, B
中科院分区：
文献类型：
--
作者：
Bridgewater, B
目的了解首次分离冠状动脉手术和主动脉瓣手术的冠名外科医生死亡率。设计前瞻性收集资料的回顾性分析。设置英格兰西北部所有开展成人心脏手术的NHS医院。研究对象是在2001年4月至2004年3月期间进行冠状动脉手术和主动脉瓣置换术的25名顾问外科医生。主要观察指标：两种手术的死亡率。EuroSCORE将患者分为低风险和高风险。结果10 163例患者在25位外科医生指导下完成手术。冠状动脉手术的平均患者数为363例，主动脉瓣置换术的平均患者数为44例。17%接受冠状动脉手术的患者和一半接受主动脉瓣手术的患者被认为是高风险的。冠状动脉手术的平均死亡率为1.8%（范围0-3.8%），主动脉瓣手术的平均死亡率为1.9%（范围0-12.5%）。两种手术的死亡率均低于全国平均水平的99%。结论两例心脏手术的死亡率在所有外科医生可接受的范围内。根据低风险和高风险患者的结果划分是不完善的，但可能有助于告知公众这类分析的复杂性，并防止外科医生回避可能从手术中受益的高风险专利。
Objectives To present named surgeon mortality for isolated first time coronary artery surgery and aortic valve surgery.Design Retrospective analysis of prospectively collected data.Setting All NHS hospitals undertaking adult cardiac surgery in north west England.Participants 25 consultant surgeons carrying out coronary artery surgery and aortic valve replacement between April 2001 and March 2004.Main outcome measures Mortality for both operations according to surgeon. EuroSCORE to stratify patients into low and high risk.Results 10 163 patients underwent surgery under 25 surgeons. The average number of patients per surgeon was 363 for coronary artery surgery and 44 for aortic valve replacement. Seventeen per cent of the patients undergoing coronary artery surgery and half of those undergoing aortic valve surgery were considered high risk. The average mortality was 1.8% (range 0-3.8%) for coronary surgery and 1.9% (0-12.5%) for aortic valve surgery. Mortality for all surgeons fell below 99% control limits of the national mean for both operations.Conclusions The presented mortality figures for the two cardiac operations fell within accepted limits for all surgeons. The division of outcomes according to low and high risk patients is imperfect but may help to inform the public about the complexities of this type of analysis and prevent surgeons avoiding high risk patents who may benefit from an operation.