Glance Laurent G, Dick Andrew, Mukamel Dana B, Li Yue, Osler Turner M
Department of Anesthesiology, University of Rochester Medical Center, 601 Elmwood Avenue, PO Box 604, Rochester, NY 14642, USA.
Health Serv Res. 2008 Feb;43(1 Pt 1):300-12. doi: 10.1111/j.1475-6773.2007.00753.x.
It is unknown whether high-risk cardiac surgical patients have less access to high-quality surgeons compared with lower-risk patients.
To determine whether high-quality surgeons are less likely to perform coronary artery bypass graft (CABG) surgery on high-risk patients compared with low-quality surgeons.
DESIGN, SETTING, AND PATIENTS: Retrospective cohort study using the New York State (NYS) CABG Surgery Reporting System (CSRS) of all patients undergoing CABG surgery in NYS who were discharged between 1997 and 1999 (51,750 patients; 2.20 percent mortality). Regression modeling was used to estimate the association between surgeon quality and patient risk of death. Surgeon quality was quantified using the observed-to-expected mortality ratio (O-to-E ratio).
Higher-risk patients are more likely to receive CABG surgery from higher-quality surgeons. For every 10 percentage point increase in patient risk of death (e.g., from 5 to 15 percent), there is an absolute reduction of 0.034 in the surgeon O-to-E ratio (p < .001).
This study suggests that high-risk CABG patients are significantly more likely to receive care from high-quality surgeons compared with lower risk patients.
与低风险患者相比，高风险心脏外科手术患者获得高质量外科医生治疗的机会是否更少尚不清楚。
确定与低质量外科医生相比，高质量外科医生对高风险患者进行冠状动脉搭桥术（CABG）的可能性是否更低。
设计、地点和患者：采用纽约州（NYS）冠状动脉搭桥术手术报告系统（CSRS）对1997年至1999年间在NYS接受冠状动脉搭桥术且已出院的所有患者进行回顾性队列研究（51750例患者；死亡率为2.20%）。使用回归模型来估计外科医生质量与患者死亡风险之间的关联。外科医生质量采用观察到的与预期的死亡率之比（O-E比）进行量化。
高风险患者更有可能接受高质量外科医生的冠状动脉搭桥术。患者死亡风险每增加10个百分点（例如，从5%增加到15%），外科医生的O-E比就会绝对降低0.034（p < 0.001）。
本研究表明，与低风险患者相比，高风险冠状动脉搭桥术患者显著更有可能接受高质量外科医生的治疗。
