冠状动脉搭桥术：中国当代心脏外科中心的表现
Coronary artery bypass graft: contemporary heart surgery center performance in China.
作者信息
Hu Shengshou, Zheng Zhe, Yuan Xin, Wang Yun, Normand Sharon-Lise T, Ross Joseph S, Krumholz Harlan M
机构信息
State Key Laboratory of Cardiovascular Disease, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
出版信息
Circ Cardiovasc Qual Outcomes. 2012 Mar 1;5(2):214-21. doi: 10.1161/CIRCOUTCOMES.111.962365. Epub 2012 Mar 6.
BACKGROUND
The use of coronary artery bypass grafting (CABG) surgery in China is growing, but little is known about hospital-level performance. We sought to characterize the variation in performance across hospitals participating in a national registry in China.
METHODS AND RESULTS
The study sample was drawn from the Chinese Cardiac Surgery Registry, a national multicenter database that includes 43 hospitals across 13 provinces and 4 direct-controlled municipalities in China. We assessed consecutive patients undergoing isolated CABG surgery during the period of January 1, 2007, through December 31, 2008. Hierarchical generalized linear models were used to estimate hospital-level risk-standardized in-hospital all-cause mortality rates (RSMR) and major complication rates (RSMCR), which included death, myocardial infarction, reoperation for bleeding, mediastinal infection, stroke, reintubation, and renal failure. Among 8739 patients who underwent isolated CABG surgery, the mean age was 62.2 years (SD=9.2), and 78% were male. Observed in-hospital mortality and complication rates were 2.2% (95% confidence interval [CI], 1.9-2.5%) and 6.6% (95% CI, 6.1-7.1%), respectively. The mean RSMR was 1.9% (SD=1.1), with a range of 0.7-5.8%, and the mean RSMCR was 6.4% (SD=1.5), with a range of 3.8-10.1%. The odds of dying and the odds of having a complication after CABG surgery at a hospital 1 SD below the average relative to a hospital 1 SD above the average were 2.06 (95% CI, 1.40-3.04) and 1.53 (95% CI, 1.31-1.79), respectively. The Eastern region had the lowest RSMR and RSMCR (1.6% and 5.8%, respectively), whereas the Central region had the highest RSMR (2.5%) and the Southern region had the highest RSMCR (7.7%).
CONCLUSIONS
Mortality and complication rates after CABG surgery in the Chinese Cardiac Surgery Registry are generally low but vary by hospital and region within China. These results suggest that there are opportunities to improve outcomes in some CABG facilities.
背景
冠状动脉旁路移植术（CABG）在中国的应用日益广泛，但关于医院层面的手术效果却知之甚少。我们试图描述参与中国一项全国性登记研究的各医院手术效果的差异。
方法与结果
研究样本取自中国心脏外科登记系统，这是一个全国性多中心数据库，涵盖中国13个省的43家医院及4个直辖市。我们评估了2007年1月1日至2008年12月31日期间接受单纯CABG手术的连续患者。采用分层广义线性模型来估计医院层面的风险标准化院内全因死亡率（RSMR）和主要并发症发生率（RSMCR），主要并发症包括死亡、心肌梗死、因出血再次手术、纵隔感染、中风、再次插管及肾衰竭。在8739例接受单纯CABG手术的患者中，平均年龄为62.2岁（标准差=9.2），男性占78%。观察到的院内死亡率和并发症发生率分别为2.2%（95%置信区间[CI]，1.9 - 2.5%）和6.6%（95%CI，6.1 - 7.1%）。平均RSMR为1.9%（标准差=1.1），范围为0.7 - 5.8%；平均RSMCR为6.4%（标准差=1.5），范围为3.8 - 10.1%。与高于平均水平1个标准差的医院相比，低于平均水平1个标准差的医院CABG手术后死亡几率和发生并发症的几率分别为2.06（95%CI，1.40 - 3.04）和1.53（95%CI，1.31 - 1.79）。东部地区的RSMR和RSMCR最低（分别为1.6%和5.8%），而中部地区的RSMR最高（2.5%），南部地区的RSMCR最高（7.7%）。
结论
中国心脏外科登记系统中CABG手术后的死亡率和并发症发生率总体较低，但因医院和地区而异。这些结果表明，一些CABG手术机构仍有改善手术效果的空间。
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