Variation in Hospital Mortality Associated with Inpatient Surgery.
Variation in Hospital Mortality Associated with Inpatient Surgery.
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DOI：
10.1056/nejmsa0903048
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发表时间：
2009-10-01
影响因子：
158.5
通讯作者：
Dimick, Justin B.
中科院分区：
文献类型：
--
作者：
Ghaferi, Amir A.;Birkmeyer, John D.;Dimick, Justin B.
背景：与住院手术相关的住院死亡率差异很大。降低术后并发症的发生率，这是支付者和监管者目前关注的焦点，可能是降低死亡率的一种方法。然而，一旦并发症发生，有效的管理可能是同样重要的。方法：我们研究了84,730例患者，他们从2005年到2007年接受了住院普外科和血管外科手术，使用的数据来自美国外科医师学会国家手术质量改进计划。我们首先根据医院的风险调整后的总体死亡率对医院进行排名，并将其分为五组。对于每一个整体死亡率五分之一的医院，我们然后评估了整体和主要并发症的发生率和死亡率之间的患者有重大complications.Results：死亡率变化很大，在医院的五分之一，从3.5%，在非常低的死亡率医院6.9%，在非常高的死亡率医院。死亡率极高或极低的医院的总体并发症（分别为24.6%和26.9%）和主要并发症（分别为18.2%和16.2%）发生率相似。住院死亡率五分位数之间的个体并发症发生率没有显著差异。相比之下，在总死亡率很高的医院中，有严重并发症的患者的死亡率几乎是总死亡率很低的医院的两倍（21.4%对12.5%，P
Background: Hospital mortality that is associated with inpatient surgery varies widely. Reducing rates of postoperative complications, the current focus of payers and regulators, may be one approach to reducing mortality. However, effective management of complications once they have occurred may be equally important.Methods: We studied 84,730 patients who had undergone inpatient general and vascular surgery from 2005 through 2007, using data from the American College of Surgeons National Surgical Quality Improvement Program. We first ranked hospitals according to their risk-adjusted overall rate of death and divided them into five groups. For hospitals in each overall mortality quintile, we then assessed the incidence of overall and major complications and the rate of death among patients with major complications.Results: Rates of death varied widely across hospital quintiles, from 3.5% in very-low-mortality hospitals to 6.9% in very-high-mortality hospitals. Hospitals with either very high mortality or very low mortality had similar rates of overall complications (24.6% and 26.9%, respectively) and of major complications (18.2% and 16.2%, respectively). Rates of individual complications did not vary significantly across hospital mortality quintiles. In contrast, mortality in patients with major complications was almost twice as high in hospitals with very high overall mortality as in those with very low overall mortality (21.4% vs. 12.5%, P