医院规模对肾动脉搭桥术住院死亡率的影响。
Effect of hospital volume on in-hospital mortality for renal artery bypass.
作者信息
Modrall J Gregory, Rosero Eric B, Smith Stephen T, Arko Frank R, Valentine R James, Clagett G Patrick, Timaran Carlos H
机构信息
Department of Surgery, Division of Vascular and Endovascular Surgery, University of Texas Southwestern Medical Center, Dallas Veterans Affairs Medical Center, Dallas, Texas 75390, USA.
出版信息
Vasc Endovascular Surg. 2009 Aug-Sep;43(4):339-45. doi: 10.1177/1538574409335919. Epub 2009 Jun 24.
BACKGROUND
A recent report determined that the nationwide mortality for renal artery bypass (RAB) is surprisingly high-10%. We hypothesized that operative mortality for RAB is related to the volume of such operations performed in each center.
METHODS
The Nationwide Inpatient Sample was analyzed to identify patients undergoing RAB for the years 2000-2005. In-hospital mortality for RAB was compared between hospitals.
RESULTS
During the study period, RAB was performed on 7413 patients with an overall in-hospital mortality of 9.6%. The multivariate logistic regression analyses revealed that after adjusting for surgical risk, increasing hospital volume was significantly associated with decreased in-hospital mortality for RAB (odds ratio 0.98; 95% confidence interval, 0.96-0.99; P=.015).
CONCLUSIONS
Patient risk profile and hospital volume are critical determinants of in-hospital mortality for RAB, which should be factored into decision making for patients requiring intervention for renovascular disease.
背景
最近一份报告显示，全国范围内肾动脉搭桥术（RAB）的死亡率出奇地高，达10%。我们推测，RAB的手术死亡率与各中心开展此类手术的数量有关。
方法
分析全国住院患者样本，以确定2000年至2005年期间接受RAB手术的患者。比较各医院RAB的住院死亡率。
结果
在研究期间，7413例患者接受了RAB手术，总体住院死亡率为9.6%。多因素逻辑回归分析显示，在调整手术风险后，医院手术量增加与RAB住院死亡率降低显著相关（比值比0.98；95%置信区间，0.96 - 0.99；P = 0.015）。
结论
患者风险状况和医院手术量是RAB住院死亡率的关键决定因素，在对需要进行肾血管疾病干预的患者进行决策时应予以考虑。
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