Silber J H, Williams S V, Krakauer H, Schwartz J S
Department of Pediatrics, School of Medicine, University of Pennsylvania, Philadelphia.
Med Care. 1992 Jul;30(7):615-29. doi: 10.1097/00005650-199207000-00004.
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.
我们探讨了预测两种常见外科手术后总体死亡率的因素是否不同于预测住院期间不良事件（并发症）或不良事件后死亡（我们称之为“抢救失败”）的因素。我们使用三种结局指标对5972例接受择期胆囊切除术或经尿道前列腺切除术的医疗保险患者进行了研究：1）死亡率（死亡人数/患者人数）；2）不良事件发生率（发生不良事件的患者人数/患者人数）；3）失败率（发生不良事件的患者中的死亡人数/发生不良事件的患者人数）。死亡率与医院和患者特征均相关。不良事件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关联更大，并且受MedisGroups评分所衡量的患者入院时疾病严重程度的影响较小。我们得出结论，与医院抢救失败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能提高我们利用死亡率统计数据帮助医院提升医疗质量的能力。
