In-Hospital Mortality Following Coronary Artery Bypass Graft Surgery in Veterans Health Administration and Private Sector Hospitals
In-Hospital Mortality Following Coronary Artery Bypass Graft Surgery in Veterans Health Administration and Private Sector Hospitals
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退伍军人健康管理局和私营医院冠状动脉搭桥手术后的院内死亡率
DOI：
10.1097/01.mlr.0000053231.70549.2d
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发表时间：
2003
期刊：
影响因子：
3
通讯作者：
E. Hannan
中科院分区：
文献类型：
--
作者：
G. Rosenthal;M. Vaughan Sarrazin;E. Hannan
目标。比较两个地理区域VA和私营医院接受冠状动脉搭桥手术（CABG）患者的严重调整后住院死亡率。研究设计。回顾性队列研究。科目。1993年10月至1996年12月，43家VA医院有心脏外科项目的连续男性患者接受了CABG (n = 19,266)；纽约州32家医院（n = 44,247）；俄亥俄州东北部的10家医院（n = 9696）。方法。人口统计和临床数据从医疗记录中提取。Logistic回归分析确定了住院死亡率的10个独立患者水平预测因子（P <0.01）：年龄、既往冠脉搭桥、冠脉搭桥前血管成形术、射血分数、糖尿病、外周血管疾病、充血性心力衰竭（CHF）、脑血管疾病、肾功能不全和慢性阻塞性肺疾病（COPD）。结果。VA患者的未调整死亡率高于纽约州或俄亥俄州东北部患者（分别为3.5%对2.0%和2.2%）。死亡率随容量的增加而降低（P <0.001）（低容量医院[<500例]为3.6%，中等容量医院[500 - 1000例]为3.0%，高容量医院[100 - 1000例]为2.0%）。退伍军人医院的中位业务量低于私营医院（410对1520），而且没有退伍军人医院被列为高业务量。调整患者水平预测因子和容量后，VA患者的死亡几率高于私营部门患者（OR, 1.34; 95% CI, 1.11-1.63;P <0.001）。在分层分析中，低容量医院的VA患者死亡几率相似（OR, 0.86;P = 0.39），但中等容量医院的VA患者死亡几率更高（OR, 1.50;P = 0.01）。结论。VA医院的冠状动脉搭桥量低于纽约州和俄亥俄州东北部的私营医院，住院死亡率更高。然而，死亡率的差异仅限于中等规模的医院。这些发现表明，在比较VA和私营医院的CABG死亡率时，医院容量是一个重要的调整因素。退伍军人医院较高的死亡率，部分原因可能是由于手术容量和患者需求的差异，导致心脏手术项目的容量较小。
Objectives. Compare severity-adjusted in-hospital mortality in patients undergoing coronary artery bypass graft surgery (CABG) in VA and private sector hospitals in two geographic regions. Research Design. Retrospective Cohort Study. Subjects. Consecutive male patients undergoing CABG from October 1993 to December 1996 in: 43 VA hospitals with cardiac surgery programs (n = 19,266); 32 hospitals in New York (NY) State (n = 44,247); and 10 hospitals in Northeast (NE) Ohio (n = 9696). Methods. Demographic and clinical data were abstracted from medical records. Logistic regression analysis identified 10 independent patient-level predictors (P <0.01) of in-hospital mortality: age, prior CABG, angioplasty before CABG, ejection fraction, diabetes, peripheral vascular disease, congestive heart failure (CHF), cerebrovascular disease, renal insufficiency, and chronic obstructive pulmonary disease (COPD). Results. Unadjusted mortality was higher in VA patients than in NY or NE Ohio patients (3.5% vs. 2.0%, and 2.2%, respectively). Mortality decreased (P <0.001) with increasing volume (3.6% in low [<500 cases], 3.0% in moderate [500–1000 cases], and 2.0% in high [>1000 cases] volume hospitals). Median volume was lower in VA than private sector hospitals (410 vs. 1520), and no VA hospitals were classified as high volume. Adjusting for patient-level predictors and volume, the odds of death was higher in VA patients, relative to private sector patients (OR, 1.34; 95% CI, 1.11–1.63;P <0.001). In stratified analyses, the odds of death in VA patients was similar in low volume hospitals (OR, 0.86;P = 0.39), but higher in moderate volume hospitals (OR, 1.50;P = 0.01). Conclusions. VA hospitals had lower CABG volume than private sector hospitals in NY and NE Ohio, and higher in-hospital mortality. However, the difference in mortality was limited to moderate-volume hospitals. These findings suggest that hospital volume is an important modifier in comparisons of CABG mortality in VA and private sector hospitals. The higher mortality in VA hospitals may, in part, be caused by differences in surgical capacity and patient demand that lead to lower volume cardiac surgery programs.
影响因子：
3
作者：
Wolinsky,FD;Coe,RM;Mosely2nd,RR
通讯作者：
Mosely2nd,RR
影响因子：
120.7
作者：
OConnor, GT;Plume, SK;Kasper, JF
通讯作者：
Kasper, JF
影响因子：
3
作者：
Rosenthal, GE;Shah, A;Harper, DL
通讯作者：
Harper, DL