Department of Surgery, University of California, San Diego2Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, Massachusetts.
Department of Surgery, University of California, San Diego.
JAMA Surg. 2014 Sep;149(9):926-32. doi: 10.1001/jamasurg.2014.1018.
IMPORTANCE: In 2003, the Agency for Healthcare Research and Quality established Patient Safety Indicators (PSIs) to monitor preventable adverse events during hospitalizations. OBJECTIVE: To evaluate the comparative safety of endovascular aneurysm repair (EVAR) vs open aneurysm repair (OAR) of abdominal aortic aneurysm by measuring PSIs associated with each procedure over time. DESIGN, SETTING, AND PARTICIPANTS: Cases of abdominal aortic aneurysm repair were extracted from the Nationwide Inpatient Sample (2003-2010). Patient Safety Indicators were calculated using Agency for Healthcare Research and Quality software (Win QI, version 4.4). Unadjusted analysis included year, age, sex, race/ethnicity, comorbidities, rupture status, hospital teaching status, and emergency status. Multivariable analysis was stratified by year for any PSI in EVAR vs OAR. Postoperative mortality was analyzed to control for the overall safety. MAIN OUTCOMES AND MEASURES: Patient Safety Indicators and mortality. RESULTS: In total, 43,385 EVARs and 27,561 OARs were documented, with 1289 (3.0%) and 3094 (11.2%) associated PSIs, respectively. Compared with those receiving OAR, patients receiving EVAR were more likely to be male, older, and of white race/ethnicity; have a lower Charlson Comorbidity Index; and seek care at teaching hospitals (P < .001 for all). Patients were less likely to have a PSI after EVAR than after OAR. Overall, multivariable analysis showed that EVAR was associated with a 42.1% decrease in the risk-adjusted odds of any PSI compared with OAR (odds ratio, 0.58; 95% CI, 0.51-0.65). Stratified by year, the risk-adjusted odds of any PSI after EVAR were comparatively less likely than after OAR every year except for 2007, and the odds of death were comparatively less every year. The annual percentage of PSIs among all aortic repairs decreased from 7.4% in 2003 to 4.4% in 2010, while the proportion of total repairs that were EVARs increased from 41.1% in 2003 to 75.3% in 2010. CONCLUSIONS AND RELEVANCE: Patient Safety Indicators can be used to monitor the comparative safety of emerging surgical technologies. Herein, EVAR was safer than OAR. The adoption of minimally invasive technology can improve safety among surgical admissions.
重要性：2003 年，医疗保健研究与质量局设立了患者安全指标（PSIs），以监测住院期间可预防的不良事件。 目的：通过测量与每种手术相关的 PSIs，评估血管内动脉瘤修复术（EVAR）与开放动脉瘤修复术（OAR）治疗腹主动脉瘤的相对安全性。 设计、地点和参与者：从全国住院患者样本（2003-2010 年）中提取腹主动脉瘤修复病例。使用医疗保健研究与质量局软件（Win QI，版本 4.4）计算患者安全指标。未调整分析包括年份、年龄、性别、种族/民族、合并症、破裂状态、医院教学状态和紧急状态。对 EVAR 与 OAR 之间的任何 PSI 进行分层分析。术后死亡率分析用于控制整体安全性。 主要结果和措施：患者安全指标和死亡率。 结果：共记录了 43385 例 EVAR 和 27561 例 OAR，分别有 1289 例（3.0%）和 3094 例（11.2%）与 PSIs 相关。与接受 OAR 的患者相比，接受 EVAR 的患者更可能是男性、年龄较大、为白种人/西班牙裔；Charlson 合并症指数较低；并在教学医院接受治疗（所有 P < .001）。与接受 OAR 的患者相比，接受 EVAR 的患者发生 PSI 的可能性较低。总体而言，多变量分析显示，与 OAR 相比，EVAR 发生任何 PSI 的风险调整后比值降低了 42.1%（比值比，0.58；95%CI，0.51-0.65）。按年份分层，除 2007 年外，EVAR 后任何 PSI 的风险调整后比值均低于 OAR 后，每年的死亡率也较低。2003 年，所有主动脉修复术的 PSI 百分比从 7.4%降至 2010 年的 4.4%，而 2003 年 EVAR 总修复术的比例从 41.1%增至 2010 年的 75.3%。 结论和相关性：患者安全指标可用于监测新兴手术技术的相对安全性。在此，EVAR 比 OAR 更安全。微创技术的采用可以提高手术入院的安全性。
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