先天性心脏病手术：根据亚里士多德复杂性评分的手术表现。
Congenital heart surgery: surgical performance according to the Aristotle complexity score.
机构信息
Department of Paediatric Cardio-Thoracic Surgery, Congential Cardiac Centre ('Deutsches Kinderherzzentrum'), Asklepios Clinic, Sankt Augustin, Germany.
出版信息
Eur J Cardiothorac Surg. 2011 Apr;39(4):e33-7. doi: 10.1016/j.ejcts.2010.11.062. Epub 2011 Jan 13.
OBJECTIVES
Aristotle score methodology defines surgical performance as 'complexity score times hospital survival'. We analysed how this performance evolved over time and in correlation with case volume.
METHODS
Aristotle basic and comprehensive complexity scores and corresponding basic and comprehensive surgical performances were determined for primary (main) procedures carried out from 2006 to 2009. Surgical case volume performance described as unit performance was estimated as 'surgical performance times the number of primary procedures'.
RESULTS
Basic and comprehensive complexity scores for the whole cohort of procedures (n=1828) were 7.74±2.66 and 9.89±3.91, respectively. With an early survival of 97.5% (1783/1828), mean basic and comprehensive surgical performances reached 7.54±2.54 and 9.64±3.81, respectively. Basic surgical performance varied little over the years: 7.46±2.48 in 2006, 7.43±2.58 in 2007, 7.50±2.76 in 2008 and 7.79±2.54 in 2009. Comprehensive surgical performance decreased from 9.56±3.91 (2006) to 9.22±3.94 (2007), and then to 9.13±3.77 (2008), thereafter increasing up to 10.62±3.67 (2009). No significant change of performance was observed for low comprehensive complexity levels 1-3. Variation concerned level 4 (p=0.048) which involved the majority of procedures (746, or 41% of cases) and level 6 (p<0.0001) which included a few cases (20, or 1%), whereas for level 5, statistical significance was almost attained: p=0.079. With a mean annual number of procedures of 457, mean basic and comprehensive unit performance was estimated at 3447±362 and 4405±577, respectively. Basic unit performance increased year to year from 3036 (2006, 100%) to 3254 (2007, 107.2%), then 3720 (2008, 122.5%), up to 3793 (2009, 124.9%). Comprehensive unit performance also increased: from 3891 (2006, 100%) to 4038 (2007, 103.8%), 4528 (2008, 116.4%) and 5172 (2009, 132.9%).
CONCLUSIONS
Aristotle scoring of surgical performance allows quality assessment of surgical management of congenital heart disease over time. The newly defined unit performance appears to well reflect the trend of activity and efficiency of a congenital heart surgery department.
目的
亚里士多德评分方法将手术表现定义为“复杂程度评分乘以医院生存率”。我们分析了这种表现随时间的变化以及与手术量的相关性。
方法
对 2006 年至 2009 年进行的主要（主要）手术确定了亚里士多德基本和综合复杂程度评分以及相应的基本和综合手术表现。作为单位表现描述的手术病例量表现估计为“手术表现乘以主要手术数量”。
结果
整个手术队列（n=1828）的基本和综合复杂程度评分分别为 7.74±2.66 和 9.89±3.91。早期生存率为 97.5%（1783/1828），平均基本和综合手术表现分别达到 7.54±2.54 和 9.64±3.81。基本手术表现多年来变化不大：2006 年为 7.46±2.48，2007 年为 7.43±2.58，2008 年为 7.50±2.76，2009 年为 7.79±2.54。综合手术表现从 9.56±3.91（2006 年）下降到 9.22±3.94（2007 年），然后下降到 9.13±3.77（2008 年），此后上升至 10.62±3.67（2009 年）。低综合复杂程度水平 1-3 的表现没有明显变化。涉及大多数病例（746 例，占病例的 41%）的第 4 级（p=0.048）和少数病例（20 例，占 1%）的第 6 级变化，而第 5 级则几乎达到了统计学意义：p=0.079。平均每年手术量为 457 例，估计基本和综合单位表现分别为 3447±362 和 4405±577。基本单位表现逐年从 3036（2006 年，100%）增加到 3254（2007 年，107.2%），然后增加到 3720（2008 年，122.5%），达到 3793（2009 年，124.9%）。综合单位表现也有所增加：从 3891（2006 年，100%）增加到 4038（2007 年，103.8%）、4528（2008 年，116.4%）和 5172（2009 年，132.9%）。
结论
亚里士多德评分法可用于随时间评估先天性心脏病手术管理的质量。新定义的单位表现似乎很好地反映了先天性心脏病手术部门活动和效率的趋势。
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