Do hospitals and surgeons with higher coronary artery bypass graft surgery volumes still have lower risk-adjusted mortality rates?
Do hospitals and surgeons with higher coronary artery bypass graft surgery volumes still have lower risk-adjusted mortality rates?
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DOI：
10.1161/01.cir.0000084551.52010.3b
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发表时间：
2003-08-19
期刊：
影响因子：
37.8
通讯作者：
Subramanian, VA
中科院分区：
文献类型：
--
作者：
Hannan, EL;Wu, CT;Subramanian, VA
作为 CABG 手术推荐体积阈值基础的背景研究已经过时，并且不能反映该领域的最新进展。本研究通过使用基于人群的临床数据集，检查了医院和外科医生进行 CABG 手术的数量与死亡率之间的关系。方法和结果——来自 1997 年至 1999 年纽约临床 CABG 手术登记处的数据（手术总数为 57150 例）用于检查在调整疾病严重程度差异后，年度医院数量和年度外科医生数量对院内死亡率的单独和综合影响。在 200 至 800 人之间的所有年度医院人数阈值以上以及 50 至 200 人之间的所有外科医生人数阈值之上，风险调整死亡率显着降低。对于 100 人的医院阈值人数 (NNT=50) 和 50 人的外科医生阈值人数 (NNT=118)，为避免死亡而需要在较高容量提供者那里接受治疗 (NNT) 的人数被最小化。在手术量大于或等于600的医院中接受手术量大于或等于125的外科医生进行手术的患者的风险调整死亡率（RAMR）为1.89%。对于接受手术量为
Background-Studies that are the basis of recommended volume thresholds for CABG surgery are outdated and not reflective of recent advances in the field. This study examines both hospital and surgeon volume-mortality relations for CABG surgery through the use of a population-based clinical data set.Methods and Results-Data from New York's clinical CABG surgery registry from 1997 to 1999 (total number of procedures, 57150) were used to examine the individual and combined impact of annual hospital volume and annual surgeon volume on in-hospital mortality rates after adjusting for differences in severity of illness. Significantly lower risk-adjusted mortality rates occurred above all annual hospital volume thresholds between 200 and 800 and above all surgeon volume thresholds between 50 and 200. The number needed to treat (NNT) at higher-volume providers to avoid a death was minimized for a hospital threshold volume of 100 (NNT=50) and a surgeon threshold volume of 50 (NNT=118). The risk-adjusted mortality rate (RAMR) for patients undergoing surgery performed by surgeons with volumes of greater than or equal to125 in hospitals with volumes of greater than or equal to600 was 1.89%. The RAMR was significantly higher (2.67%) for patients undergoing surgery performed by surgeons with volumes of