Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
Health Serv Res. 2014 Oct;49(5):1659-69. doi: 10.1111/1475-6773.12174. Epub 2014 Apr 9.
To assess the hypothesis that postoperative survival exhibits heterogeneity associated with the timing of quality metrics.
Retrospective observational study using the Nationwide Inpatient Sample from 2005 through 2009.
Survival analysis was performed on all admission records with a procedure code for major cardiac surgery (n = 595,089). The day-by-day hazard function for all-cause in-hospital mortality at 1-day intervals was analyzed using joinpoint regression (a data-driven method of testing for changes in hazard).
A comprehensive analysis of a publicly available national administrative database was performed.
Statistically significant shifts in the pattern of postoperative mortality occurred at day 6 (95 percent CI = day 5-8) and day 30 (95 percent CI = day 20-35).
While the shift at day 6 plausibly can be attributed to the separation between routine recovery and a complicated postoperative course, the abrupt increase in mortality at day 30 has no clear organic etiology. This analysis raises the possibility that this observed shift may be related to clinician behavior because of the use of 30-day mortality as a quality metric, but further studies will be required to establish causality.
评估术后生存与质量指标时间相关的异质性假设。
使用 2005 年至 2009 年全国住院患者样本的回顾性观察性研究。
对所有主要心脏手术程序代码的入院记录进行生存分析（n=595089）。使用连接点回归（一种用于测试危险变化的基于数据的方法）分析全因住院死亡率的逐日危险函数，间隔 1 天。
对公共可用的国家行政数据库进行全面分析。
术后死亡率模式在第 6 天（95%CI=第 5-8 天）和第 30 天（95%CI=第 20-35 天）出现了统计学上显著的变化。
虽然第 6 天的转变可能归因于常规康复和复杂术后过程之间的分离，但第 30 天死亡率的突然增加没有明确的有机病因。这项分析提出了这样一种可能性，即这种观察到的转变可能与临床医生的行为有关，因为使用 30 天死亡率作为质量指标，但需要进一步的研究来确定因果关系。
