Association of Treatment for Critical Limb Ischemia with Gender and Hospital Volume
Association of Treatment for Critical Limb Ischemia with Gender and Hospital Volume
复制标题
严重肢体缺血的治疗与性别和医院容量的关系
DOI：
10.1177/000313481808400668
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发表时间：
2018
期刊：
影响因子：
--
通讯作者：
L. Nguyen
中科院分区：
文献类型：
--
作者：
Maria J. Schaumeier;A. Hawkins;N. Hevelone;R. Sethi;L. Nguyen
严重肢体缺血 (CLI) 是一种常见的主要血管问题，尽管进行了血运重建手术，仍可能导致截肢和死亡。研究表明，与男性相比，女性的 CLI 血运重建率低 3% 至 4%，且预后较差。我们假设这种差异是由于女性更有可能进入低容量医院，从而导致血运重建次数较少。前瞻性队列研究。使用 2007 年至 2010 年全国住院患者样本的数据来确定具有 CLI 主要国际疾病分类 9 代码的入院情况（国际疾病分类 9 代码：440.22、440.23、440.24、707.1、707.10-707.15 或 707.19）。根据年度血运重建手术将医院分为五分位数。进行双变量分析，并使用多变量逻辑回归分析血运重建、截肢和死亡率的几率，同时控制患者和医院层面的因素。在 113,631 名住院患者中，有 54,370 名 (47.8%) 是女性，她们更有可能入住低容量医院（极低：49.6% 对比极高：47.1%；P < 0.001）。在所有体积五分位数中，女性的血运重建率较低（31.6% vs 35.1%，P < 0.001），而使用开放手术血运重建的差异最大（12.5% vs 16.0%，P < 0.001）。在多变量分析中，女性[比值比 (OR) 0.87，95% 置信区间 (CI) 0.83–0.92，P < 0.001] 和极低的医院容量（OR 0.21，95% CI 0.17–0.26，P < 0.001）均与较低的血运重建率显着相关。与男性相比，女性发生大截肢的几率较低（OR 0.75，95% CI 0.69-0.82，P < 0.001），而在大容量医院接受治疗与截肢几率增加相关（OR 1.37，95% CI 1.09-1.73，P = 0.008）。在多变量回归模型中，性别和住院人数均与院内死亡率无关。女性更有可能被送往低容量医院接受 CLI 治疗。因此，他们接受血运重建的可能性较小，尽管他们的大截肢率也较低。
Critical limb ischemia (CLI) is a frequent and major vascular problem and can lead to amputation and death despite surgical revascularization. Women have been shown to have 3 to 4 per cent lower revascularization rates for CLI compared with men as well as inferior outcomes. We hypothesize that this difference is a result of women being more likely admitted to low-volume hospitals, which in turn perform fewer revascularizations. Prospective cohort study. Data from the Nationwide Inpatient Sample 2007 to 2010 were used to identify admissions with primary International Classification of Diseases-9 codes for CLI (International Classification of Diseases-9 codes: 440.22, 440.23, 440.24, 707.1, 707.10–707.15, or 707.19). Hospitals were grouped in quintiles by annual revascularization procedures. Bivariate analyses were performed and multivariable logistic regression was used to analyze the odds of revascularization, amputation, and mortality while controlling for patient and hospital-level factors. Of 113,631 admissions, 54,370 (47.8%) were women, who were more likely admitted to low-volume hospitals (very low: 49.6% vs very high: 47.1%; P < 0.001). Revascularization rates were lower in women (31.6% vs 35.1%, P < 0.001) across all volume quintiles, whereas the difference was greatest in the use of open surgical revascularization (12.5% vs 16.0%, P < 0.001). In multivariable analysis, female gender [odds ratio (OR) 0.87, 95% confidence interval (CI) 0.83–0.92, P < 0.001] and very-low hospital volume (OR 0.21, 95% CI 0.17–0.26, P < 0.001) were both significantly associated with lower rates of revascularization. Women had lower odds of major amputation compared with men (OR 0.75, 95% CI 0.69–0.82, P < 0.001), whereas treatment in a very high-volume hospital was associated with increased odds for amputation (OR 1.37, 95% CI 1.09–1.73, P = 0.008). Neither gender nor hospital volume were independently associated with in-hospital mortality in the multivariable regression model. Women are more likely to be admitted to low-volume hospitals for treatment of CLI. Because of this, they are less likely to undergo revascularization, although they also had lower rates of major amputation.
何时结束：多次血运重建后截肢和死亡的风险增加。
影响因子：
1.5
作者：
Hawkins,AlexanderT;Schaumeier,MariaJ;Smith,AnnD;Hevelone,NathanaelD;Nguyen,LouisL
通讯作者：
Nguyen,LouisL
医院容量对心血管手术死亡率种族差异的影响。
影响因子：
24
作者：
Trivedi,AmalN;Sequist,ThomasD;Ayanian,JohnZ
通讯作者：
Ayanian,JohnZ