HOSPITAL AND PATIENT CHARACTERISTICS ASSOCIATED WITH DEATH AFTER SURGERY - A STUDY OF ADVERSE OCCURRENCE AND FAILURE TO RESCUE
HOSPITAL AND PATIENT CHARACTERISTICS ASSOCIATED WITH DEATH AFTER SURGERY - A STUDY OF ADVERSE OCCURRENCE AND FAILURE TO RESCUE
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DOI：
10.1097/00005650-199207000-00004
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发表时间：
1992-07-01
期刊：
影响因子：
3
通讯作者：
WILLIAMS, SV
中科院分区：
文献类型：
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作者：
SILBER, JH;WILLIAMS, SV
我们询问预测两种常见外科手术后总体死亡率的因素是否与预测住院期间不良事件（并发症）或不良事件发生后死亡（我们称之为“抢救失败”）的因素不同。我们使用三种结果指标检查了 5,972 名接受选择性胆囊切除术或经尿道前列腺切除术的医疗保险患者：1) 死亡率（死亡人数/患者人数）； 2) 不良发生率（发生不良事件的患者数/患者数）； 3) 失败率（发生不良事件的患者死亡人数/发生不良事件的患者人数）。死亡率与医院和患者特征相关。不良发生率主要与患者特征相关。相比之下，抢救失败与医院特征的相关性更大，并且受 MedisGroups 评分衡量的患者入院疾病严重程度的影响较小。我们的结论是，与医院未能抢救相关的因素不同于与不良事件或死亡相关的因素。了解不同医院死亡率差异背后的原因应该提高我们利用死亡率统计数据帮助医院提高护理质量的能力。
We asked if the factors that predict overall mortality following two common surgical procedures are different from those that predict adverse occurrences (complications) during the hospitalization or death after an adverse occurrence, which we refer to as "failure to rescue." We examined 5,972 Medicare patients undergoing elective cholecystectomy or transurethral prostatectomy using three outcome measures: 1) the death rate (number of deaths/number of patients); 2) the adverse occurrence rate (number of patients who developed an adverse occurrence/number of patients); and 3) the failure rate (number of deaths in patients who developed an adverse occurrence/number of patients with an adverse occurrence). The death rate was associated with both hospital and patient characteristics. The adverse occurrence rate was associated primarily with patient characteristics. In contrast, failure to rescue was associated more with hospital characteristics, and was less influenced by patient admission severity of illness as measured by the MedisGroups score. We concluded that factors associated with hospital failure to rescue are different from factors associated with adverse occurrences or death. Understanding the reasons behind variation in mortality rates across hospitals should improve our ability to use mortality statistics to help hospitals upgrade the quality of care.