Roos L L, Fisher E S, Sharp S M, Newhouse J P, Anderson G, Bubolz T A
Department of Community Health Sciences, University of Manitoba, Winnipeg, Canada.
JAMA. 1990 May 9;263(18):2453-8.
Per capita hospital expenditures in the United States exceed those in Canada, but little research has examined differences in outcomes. We used insurance databases to compare postsurgical mortality for 11 specific surgical procedures, both before and after adjustment for case mix, among residents of New England and Manitoba who were over 65 years of age. For low- and moderate-risk procedures, 30-day mortality rates were similar in both regions, but 6-month mortality rates were lower in Manitoba. For the two high-risk procedures, concurrent coronary bypass/valve replacement and hip fracture repair, both 30-day and 6-month mortality rates were lower in New England. Although no consistent pattern favoring New England for cardiovascular surgery was found, the increased mortality following hip fracture in Manitoba was found for all types of repair and all age groups. We conclude that for low- and moderate-risk procedures, the higher hospital expenditures in New England were not associated with lower perioperative mortality rates.
美国人均医院支出超过加拿大，但很少有研究考察结果差异。我们利用保险数据库，比较了新英格兰和曼尼托巴65岁以上居民在11种特定外科手术术后的死亡率，比较了病例组合调整前后的情况。对于低风险和中等风险手术，两个地区的30天死亡率相似，但曼尼托巴的6个月死亡率较低。对于两种高风险手术，即同期冠状动脉搭桥/瓣膜置换术和髋部骨折修复术，新英格兰的30天和6个月死亡率均较低。虽然未发现有利于新英格兰进行心血管手术的一致模式，但在曼尼托巴，所有类型的修复手术和所有年龄组的髋部骨折后死亡率均有所上升。我们得出结论，对于低风险和中等风险手术，新英格兰较高的医院支出与较低的围手术期死亡率无关。
