Farjah Farhood, Backhus Leah, Cheng Aaron, Englum Brian, Kim Sunghee, Saha-Chaudhuri Paramita, Wood Douglas E, Mulligan Michael S, Varghese Thomas K
Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash; Surgical Outcomes Research Center, University of Washington, Seattle, Wash.
Division of Cardiothoracic Surgery, University of Washington, Seattle, Wash.
J Thorac Cardiovasc Surg. 2015 May;149(5):1365-71; discussion 1371-3.e3. doi: 10.1016/j.jtcvs.2015.01.063. Epub 2015 Feb 11.
Failure to rescue is defined as death after an acute inpatient event and has been observed among hospitals that perform general, vascular, and cardiac surgery. This study aims to evaluate variation in complication and failure to rescue rates among hospitals that perform pulmonary resection for lung cancer.
By using the Society of Thoracic Surgeons General Thoracic Surgery Database, a retrospective, multicenter cohort study was performed of adult patients with lung cancer who underwent pulmonary resection. Hospitals participating in the Society of Thoracic Surgeons General Thoracic Surgery Database were ranked by their risk-adjusted, standardized mortality ratio (using random effects logistic regression) and grouped into quintiles. Complication and failure to rescue rates were evaluated across 5 groups (very low, low, medium, high, and very high mortality hospitals).
Between 2009 and 2012, there were 30,000 patients cared for at 208 institutions participating in the Society of Thoracic Surgeons General Thoracic Surgery Database (median age, 68 years; 53% were women, 87% were white, 71% underwent lobectomy, 65% had stage I). Mortality rates varied over 4-fold across hospitals (3.2% vs 0.7%). Complication rates occurred more frequently at hospitals with higher mortality (42% vs 34%, P < .001). However, the magnitude of variation (22%) in complication rates dwarfed the 4-fold magnitude of variation in failure to rescue rates (6.8% vs 1.7%, P < .001) across hospitals.
Variation in hospital mortality seems to be more strongly related to rescuing patients from complications than to the occurrence of complications. This observation is significant because it redirects quality improvement and health policy initiatives to more closely examine and support system-level changes in care delivery that facilitate early detection and treatment of complications.
未能成功挽救是指急性住院事件后死亡，在进行普通外科、血管外科和心脏外科手术的医院中已观察到这种情况。本研究旨在评估进行肺癌肺切除术的医院之间并发症和未能成功挽救率的差异。
通过使用胸外科医师协会普通胸外科数据库，对接受肺切除术的成年肺癌患者进行了一项回顾性多中心队列研究。参与胸外科医师协会普通胸外科数据库的医院根据其风险调整后的标准化死亡率（使用随机效应逻辑回归）进行排名，并分为五等分。对五组（死亡率非常低、低、中、高和非常高的医院）的并发症和未能成功挽救率进行了评估。
在2009年至2012年期间，208家参与胸外科医师协会普通胸外科数据库的机构共诊治了30000名患者（中位年龄68岁；53%为女性，87%为白人，71%接受肺叶切除术，65%为I期）。不同医院的死亡率相差4倍多（3.2%对0.7%）。死亡率较高的医院并发症发生率更高（42%对34%，P<.001）。然而，不同医院之间并发症发生率的差异幅度（22%）远高于未能成功挽救率的4倍差异幅度（6.8%对1.7%，P<.001）。
医院死亡率的差异似乎与从并发症中挽救患者的能力比与并发症的发生更密切相关。这一观察结果具有重要意义，因为它将质量改进和卫生政策举措重新导向，以更密切地检查和支持护理提供方面的系统层面变化，这些变化有助于早期发现和治疗并发症。
