Department of Surgery, University of Virginia Health System, Charlottesville, VA, USA.
J Am Coll Surg. 2011 Jun;212(6):1000-7. doi: 10.1016/j.jamcollsurg.2011.03.012. Epub 2011 Apr 9.
Previous studies have demonstrated the influence of academic season on outcomes in select surgical populations. However, the influence of academic season has not been evaluated nationwide in cardiac surgery. We hypothesized that cardiac surgical outcomes were not significantly influenced by time of year at both cardiothoracic teaching hospitals and non-cardiothoracic teaching hospitals nationwide.
From 2003 to 2007, a weighted 1,614,394 cardiac operations were evaluated using the Nationwide Inpatient Sample database. Patients undergoing cardiac operations at cardiothoracic teaching and non-cardiothoracic teaching hospitals were identified using the Association of American Medical College's Graduate Medical Education Tracking System. Hierarchic multivariable logistic regression analyses were used to estimate the effect of academic quarter on risk-adjusted outcomes.
Mean patient age was 65.9 ± 10.9 years. Women accounted for 32.8% of patients. Isolated coronary artery bypass grafting was the most common operation performed (64.7%), followed by isolated valve replacement (19.3%). The overall incidence of operative mortality and composite postoperative complication rate were 2.9% and 27.9%, respectively. After accounting for potentially confounding risk factors, timing of operation by academic quarter did not independently increase risk-adjusted mortality (p = 0.12) or morbidity (p = 0.24) at academic medical centers.
Risk-adjusted mortality and morbidity for cardiac operations were not associated with time of year in the US at teaching and nonteaching hospitals. Patients should be reassured of the safety of performance of cardiac operations at academic medical centers throughout a given academic year.
先前的研究已经证明了学术季节对某些外科手术人群的结果有影响。然而，学术季节对全国范围内的心脏手术的影响尚未进行评估。我们假设，在全国范围内的心胸教学医院和非心胸教学医院中，心脏手术的结果不受一年中时间的影响。
从 2003 年到 2007 年，使用全国住院患者样本数据库评估了 1614394 例加权心脏手术。使用美国医学院协会研究生医学教育跟踪系统识别在心胸教学医院和非心胸教学医院进行心脏手术的患者。使用层次多变量逻辑回归分析来估计学术季度对风险调整结果的影响。
患者平均年龄为 65.9 ± 10.9 岁。女性占患者的 32.8%。单纯冠状动脉旁路移植术是最常见的手术（64.7%），其次是单纯瓣膜置换术（19.3%）。手术死亡率和复合术后并发症发生率的总体发生率分别为 2.9%和 27.9%。在考虑到潜在的混杂风险因素后，学术季度的手术时间并不能独立增加教学医院的风险调整死亡率（p = 0.12）或发病率（p = 0.24）。
在美国的教学和非教学医院，心脏手术的风险调整死亡率和发病率与一年中的时间无关。患者应放心在学术医学中心的特定学年内进行心脏手术的安全性。
