Complications and Failure to Rescue After Inpatient Noncardiac Surgery in the Veterans Affairs Health System
Complications and Failure to Rescue After Inpatient Noncardiac Surgery in the Veterans Affairs Health System
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DOI：
10.1001/jamasurg.2016.2920
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发表时间：
2016-12-01
期刊：
影响因子：
16.9
通讯作者：
Wilson, Mark A.
中科院分区：
文献类型：
--
作者：
Massarweh, Nader N.;Kougias, Panagiotis;Wilson, Mark A.
重要性 在实施退伍军人事务部 (VA) 国家手术质量改进计划（现称为 VA 手术质量改进计划）后，退伍军人健康管理局的外科护理质量在 20 世纪 90 年代显着提高。尽管最近对私营部门的手术护理进行了许多评估，但迄今为止，尚未在 VA 卫生系统内进行当代全球评估。 目的 提供过去 15 年 VA 卫生系统中非心脏术后结果的同期报告。 设计、设置和参与者 使用 VA 手术质量改进计划的数据，对接受住院普通、血管、 1999 年 10 月 1 日至 2014 年 9 月 30 日期间进行的胸部、泌尿生殖、神经外科、骨科或脊柱手术。主要结果和测量随时间推移的 30 天发病率、死亡率和抢救失败 (FTR) 率。 结果 在 704 901 名患者中（平均 [SD] 年龄，63.7 [11.8] 岁； 676 750 [96%] 男性）在 143 家医院接受非心脏外科手术，97 836 例患者（13.9%）发生并发症，66 816 例（9.5%）发生重大并发症，97 836 例并发症患者中 12 648 例发生 FTR（12.9%），66 例发生重大并发症后的 FTR 为 12 223 例816例患者出现严重并发症（18.3%），18 924例患者（2.7%）在手术30天内死亡。从 2000 年到 2014 年，发病率（59 421 例中的 8202 例 [13.8%] 对比 32 785 例中的 3368 例 [10.3%]）、主要并发症（59 421 例中的 5832 例 [9.8%] 对比 32 785 例中的 2284 例 [7%]）、FTR（32 785 例中的 1445 例 [7%]）均显着下降。 8202 [17.6%] vs 3368 中的 351 [10.4%]），以及主要并发症后的 FTR（5832 中的 1388 [23.8%] vs 2284 中的 343 [15%]）（趋势检验，P
IMPORTANCE The quality of surgical care in the Veterans Health Administration improved markedly in the 1990s after implementation of the Veterans Affairs (VA) National Surgical Quality Improvement Program (now called the VA Surgical Quality Improvement Program). Although there have been many recent evaluations of surgical care in the private sector, to date, a contemporary global evaluation has not been performed within the VA health system.OBJECTIVE To provide a contemporaneous report of noncardiac postoperative outcomes in the VA health system during the past 15 years.DESIGN, SETTING, AND PARTICIPANTS A retrospective cohort study was conducted using data from the VA Surgical Quality Improvement Program among veterans who underwent inpatient general, vascular, thoracic, genitourinary, neurosurgical, orthopedic, or spine surgery from October 1, 1999, through September 30, 2014.MAIN OUTCOMES AND MEASURES Rates of 30-day morbidity, mortality, and failure to rescue (FTR) over time.RESULTS Among 704 901 patients (mean [SD] age, 63.7 [11.8] years; 676 750 [96%] male) undergoing noncardiac surgical procedures at 143 hospitals, complications occurred in 97 836 patients (13.9%), major complications occurred in 66 816 (9.5%), FTR occurred in 12 648 of the 97 836 patients with complications (12.9%), FTR after major complications occurred in 12 223 of the 66 816 patients with major complications (18.3%), and 18 924 patients (2.7%) died within 30 days of surgery. There were significant decreases from 2000 to 2014 in morbidity (8202 of 59 421 [13.8%] vs 3368 of 32 785 [10.3%]), major complications (5832 of 59 421 [9.8%] vs 2284 of 32 785 [7%]), FTR (1445 of 8202 [17.6%] vs 351 of 3368 [10.4%]), and FTR after major complications (1388 of 5832 [23.8%] vs 343 of 2284 [15%]) (trend test, P