Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL 60611, USA.
Ann Surg. 2013 Mar;257(3):483-9. doi: 10.1097/SLA.0b013e318273bf17.
To develop a reliable, robust, parsimonious, risk-adjusted 30-day composite colectomy outcome measure.
A fundamental aspect in the pursuit of high-quality care is the development of valid and reliable performance measures in surgery. Colon resection is associated with appreciable morbidity and mortality and therefore is an ideal quality improvement target.
From 2010 American College of Surgeons National Surgical Quality Improvement Program data, patients were identified who underwent colon resection for any indication. A composite outcome of death or any serious morbidity within 30 days of the index operation was established. A 6-predictor, parsimonious model was developed and compared with a more complex model with more variables. National caseload requirements were calculated on the basis of increasing reliability thresholds.
From 255 hospitals, 22,346 patients were accrued who underwent a colon resection in 2010, most commonly for neoplasm (46.7%). A mortality or serious morbidity event occurred in 4461 patients (20.0%). At the hospital level, the median composite event rate was 20.7% (interquartile range: 15.8%-26.3%). The parsimonious model performed similarly to the full model (Akaike information criterion: 19,411 vs 18,988), and hospital-level performance comparisons were highly correlated (R = 0.97). At a reliability threshold of 0.4, 56 annual colon resections would be required and achievable at an estimated 42% of US and 69% of American College of Surgeons National Surgical Quality Improvement Program hospitals. This 42% of US hospitals performed approximately 84% of all colon resections in the country in 2008.
It is feasible to design a measure with a composite outcome of death or serious morbidity after colon surgery that has a low burden for data collection, has substantial clinical importance, and has acceptable reliability.
开发一种可靠、稳健、简约、风险调整的 30 天综合结肠切除术结果测量方法。
追求高质量护理的一个基本方面是在外科手术中开发有效和可靠的绩效衡量标准。结肠切除术与相当大的发病率和死亡率相关，因此是质量改进的理想目标。
从 2010 年美国外科医师学会国家手术质量改进计划的数据中，确定了因任何原因接受结肠切除术的患者。建立了指数手术后 30 天内死亡或任何严重并发症的综合结果。开发了一个 6 个预测因子、简约的模型，并与具有更多变量的更复杂模型进行了比较。根据增加的可靠性阈值计算了全国病例量要求。
从 255 家医院中，共纳入 22346 例 2010 年接受结肠切除术的患者，最常见的原因是肿瘤（46.7%）。4461 例患者发生死亡或严重并发症（20.0%）。在医院层面，综合事件发生率中位数为 20.7%（四分位间距：15.8%-26.3%）。简约模型的表现与完整模型相似（Akaike 信息准则：19411 与 18988），并且医院层面的性能比较高度相关（R = 0.97）。在可靠性阈值为 0.4 时，需要进行 56 例年度结肠切除术，在美国和美国外科医师学会国家手术质量改进计划医院中约有 42%和 69%的医院可以实现这一目标。2008 年，美国约 42%的医院完成了全国 84%的结肠切除术。
设计一种以结肠手术后死亡或严重并发症为综合结果的测量方法是可行的，这种方法数据收集负担低，具有重要的临床意义，且可靠性可接受。
