Dodson John A, Wang Yun, Desai Mayur M, Barreto-Filho Jose Augusto, Sugeng Lissa, Hashim Sabet W, Krumholz Harlan M
Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT 06510, USA.
Circ Cardiovasc Qual Outcomes. 2012 May;5(3):298-307. doi: 10.1161/CIRCOUTCOMES.112.966077. Epub 2012 May 10.
Mitral valve surgery in older adults carries with it substantial morbidity and mortality risks, yet there are a paucity of national surveillance data. Therefore, we sought to determine trends in hospitalization rate, readmission, and mortality among Medicare fee-for-service (FFS) patients undergoing mitral valve surgery.
Inpatient Medicare standard analytic files were used to identify 100% of FFS patients aged ≥ 65 years who underwent mitral valve surgery between 1999 and 2008. We constructed a denominator file from Medicare administrative data to report hospitalization rates for mitral valve surgery (total and isolated) per 100 000 beneficiary-years. For isolated mitral valve surgery, 30-day readmission, 30-day mortality, and 1-year mortality outcomes were ascertained through corresponding inpatient and vital status files, and risk-standardized rates were calculated adjusting for age, sex, race, and comorbidities. During 1999 to 2008, the overall rate of mitral valve surgery per 100K beneficiary-years declined (56/100K to 51/100K), and the proportion of patients undergoing mitral valve repair (versus replacement) increased (24.7% to 46.9%, P<0.001). For isolated mitral valve surgery, there were significant declines in risk-adjusted 30-day mortality (8.1% to 4.2%, P<0.001 for trend) and 1-year mortality (15.3% to 9.2%, P=0.003 for trend) and a slight decline in risk-adjusted 30-day readmission (23.0% to 21.0%, P=0.035 for trend) over the study period. Mortality rates decreased in all age, sex, and race subgroups, and among patients undergoing mitral valve repair or replacement, but remained higher among patients aged ≥ 85 years, women, and nonwhites.
Between 1999 and 2008, outcomes after isolated mitral valve surgery significantly improved among Medicare FFS patients. Disparities among demographic subgroups indicate potential areas for quality improvement.
老年患者进行二尖瓣手术存在较高的发病和死亡风险，但目前缺乏全国性的监测数据。因此，我们试图确定医疗保险按服务收费（FFS）患者二尖瓣手术后的住院率、再入院率和死亡率趋势。
利用住院医疗保险标准分析文件，确定了1999年至2008年间100%年龄≥65岁的接受二尖瓣手术的FFS患者。我们根据医疗保险管理数据构建了一个分母文件，以报告每10万名受益年中二尖瓣手术（包括全部和单纯手术）的住院率。对于单纯二尖瓣手术，通过相应的住院和生命状态文件确定30天再入院率、30天死亡率和1年死亡率，并计算风险标准化率，对年龄、性别、种族和合并症进行调整。在1999年至2008年期间，每10万受益年中二尖瓣手术的总体发生率下降（从56/10万降至51/10万），接受二尖瓣修复（而非置换）的患者比例增加（从24.7%增至46.9%，P<0.001）。对于单纯二尖瓣手术，在研究期间，风险调整后的30天死亡率（从8.1%降至4.2%，趋势P<0.001）和1年死亡率（从15.3%降至9.2%，趋势P=0.003）显著下降，风险调整后的30天再入院率略有下降（从23.0%降至21.0%，趋势P=0.035）。所有年龄、性别和种族亚组以及接受二尖瓣修复或置换的患者死亡率均下降，但85岁及以上患者、女性和非白人患者的死亡率仍然较高。
1999年至2008年间，医疗保险FFS患者单纯二尖瓣手术后的结局显著改善。人口统计学亚组之间的差异表明了质量改进的潜在领域。
