From the Rollins School of Public Health, Emory University, Atlanta, GA (S.D.C.); Baystate Health, Springfield, MA (A.D.K.); HealthTrust Purchasing Group, L.P., Nashville, TN (P.P.B., A.W.S.); and Lahey Hospital & Medical Center, Burlington, MA (M.R.R.).
Circulation. 2015 Jan 27;131(4):362-70; discussion 370. doi: 10.1161/CIRCULATIONAHA.114.012485. Epub 2014 Dec 22.
This study reports on the trends in the volume and outcomes of coronary revascularization procedures performed on Medicare beneficiaries between 2008 and 2012.
This retrospective study identifies all Medicare beneficiaries undergoing a coronary revascularization procedure: coronary artery bypass graft surgery or percutaneous coronary intervention (PCI) performed in either the nonadmission or inpatient setting. International Classification of Diseases, 9th Revision, Clinical Modification procedure codes (inpatient setting) and Current Procedural Terminology and Ambulatory Payment Classification codes (nonadmission) were used to identify revascularizations. The study population consists of 2,768,007 records. This study finds that the rapid growth in nonadmission PCIs performed on Medicare beneficiaries (60,405-106,495) has been more than offset by the decrease in PCI admissions (363,384-295,434) during the study period. There also were >18,000 fewer coronary artery bypass graft admissions in 2012 than in 2008. This study finds lower observed mortality rates (3.7%-3.2%) among Medicare beneficiaries undergoing any coronary artery bypass graft surgery and higher observed mortality rates (1.7%-1.9%) for Medicare beneficiaries undergoing any PCI encounter. This study also finds a growth in the number of facilities performing revascularization procedures during the study period: 268 (20.2%) more sites were performing nonadmission PCIs; 136 (8.2%) more sites were performing inpatient PCIs; and 19 (1.6%) more sites were performing coronary artery bypass graft surgery.
The total number of revascularization procedures performed on Medicare beneficiaries peaked in 2010 and declined by >4% per year in 2011 and 2012. Observed mortality rates among all Medicare beneficiaries undergoing any coronary revascularization remained between 2.1% and 2.2% annually during the study period.
本研究报告了 2008 年至 2012 年间，医疗保险受益人群进行冠状动脉血运重建术的数量和结果趋势。
本回顾性研究确定了所有接受冠状动脉血运重建术的医疗保险受益人群：非住院或住院环境下进行的冠状动脉旁路移植术或经皮冠状动脉介入治疗（PCI）。采用国际疾病分类，第 9 修订版，临床修正程序代码（住院环境）和当前程序术语和门诊支付分类代码（非住院）来识别血运重建术。研究人群由 2768007 份记录组成。本研究发现，医疗保险受益人群非住院 PCI 的快速增长（60405-106495）已超过同期 PCI 住院人数的减少（363384-295434）。2012 年接受冠状动脉旁路移植术的住院人数也比 2008 年减少了超过 18000 例。本研究发现，任何冠状动脉旁路移植术的医疗保险受益人群的观察死亡率（3.7%-3.2%）较低，而任何 PCI 手术的医疗保险受益人群的观察死亡率（1.7%-1.9%）较高。本研究还发现，在研究期间进行血运重建术的医疗机构数量有所增加：非住院 PCI 的实施机构增加了 268 家（20.2%）；住院 PCI 的实施机构增加了 136 家（8.2%）；冠状动脉旁路移植术的实施机构增加了 19 家（1.6%）。
医疗保险受益人群进行的血运重建术总数在 2010 年达到峰值，随后在 2011 年和 2012 年每年下降超过 4%。在研究期间，所有接受任何冠状动脉血运重建术的医疗保险受益人群的观察死亡率保持在每年 2.1%至 2.2%之间。
