Tu J V, Austin P C, Johnston K W
Institute for Clinical Evaluative Sciences (ICES), the Division of General Internal Medicine and Clinical Epidemiology and Health Care Research Program at Sunnybrook and Women's College Health Science Centre, University of Toronto, Canada.
J Vasc Surg. 2001 Mar;33(3):447-52. doi: 10.1067/mva.2001.113487.
The aim of this study was to determine the independent impact of surgeon speciality training (vascular, cardiac, or general surgery) on the 30-day risk-adjusted mortality rate after elective abdominal aortic aneurysm (AAA) surgery.
All patients undergoing elective AAA surgery in Ontario between April 1, 1992, and March 31, 1996, were included. A retrospective cohort study with linked administrative databases was undertaken.
The average 30-day mortality rate was 4.1%. Of the 5878 cases studied, 4415 (75.1%) were performed by 63 vascular surgeons, 1193 (20.3%) by 53 general surgeons, and 270 (4.6%) by 14 cardiac surgeons. After the adjustment for potential confounding factors of annual surgeon AAA volume, type of hospital, and patient age, sex, Charlson comorbidity score, and transfer status, the odds of patients dying were 62% higher when the surgery was performed by a general surgeon than when it was performed by a vascular surgeon. Cardiac surgeons' patient outcomes were similar to those of vascular surgeons.
Patients who undergo elective AAA repair that is performed by vascular or cardiac surgeons have significantly lower mortality rates than patients who have their aneurysms repaired by general surgeons. These results provide evidence that surgical specialty training in vascular procedures leads to better patient outcomes.
本研究旨在确定外科医生专业培训（血管外科、心脏外科或普通外科）对择期腹主动脉瘤（AAA）手术后30天风险调整死亡率的独立影响。
纳入1992年4月1日至1996年3月31日在安大略省接受择期AAA手术的所有患者。采用回顾性队列研究，并与行政数据库相链接。
30天平均死亡率为4.1%。在5878例研究病例中，63名血管外科医生实施了4415例（75.1%），53名普通外科医生实施了1193例（20.3%），14名心脏外科医生实施了270例（4.6%）。在对每年外科医生AAA手术量、医院类型以及患者年龄、性别、查尔森合并症评分和转诊状态等潜在混杂因素进行调整后，由普通外科医生实施手术的患者死亡几率比由血管外科医生实施手术的患者高62%。心脏外科医生的患者预后与血管外科医生相似。
接受血管外科或心脏外科医生实施的择期AAA修复手术的患者死亡率显著低于接受普通外科医生修复动脉瘤手术的患者。这些结果证明血管手术方面的外科专业培训能带来更好的患者预后。
