Panjasawatwong Krit, Lin Peirong, Karimi Nika, You Jing, Sessler Daniel I
Department of Outcomes Research, Anesthesiology Institute, Cleveland Clinic, 9500 Euclid Ave P77, Cleveland, OH, 44195, USA.
Departments of Quantitative Health Science, Cleveland Clinic, 9500 Euclid Ave P77, Cleveland, OH, 44195, USA.
J Anesth. 2017 Feb;31(1):111-119. doi: 10.1007/s00540-016-2273-3. Epub 2016 Oct 31.
When physicians become patients, they may expect special privileges, extra attention from caregivers, and non-routine treatments. Consequently, physician patients may not be treated per routine-which possibly worsens care rather than improving it. We thus tested the primary hypothesis that in-hospital mortality and major complications after non-cardiac surgery are more common in physician patients than in non-physician patients.
Perioperative data were extracted for patients who had non-cardiac surgery at the Cleveland Clinic between 2005 and 2013. We used propensity score matching to identify comparable groups of physician and non-physician patients. Matched physician and non-physician patients were compared on a composite of in-hospital mortality and major postoperative complications using a generalized equation average relative effects model. Secondly, the matched patients were also compared on reoperation using logistic regression and on duration of hospitalization using Kaplan-Meier analysis with the log-rank test and Cox proportional hazards regression.
Among 21,173 qualifying patients, we matched 522 physician patients to 2448 non-physician controls. There were no significant differences between physician and non-physician patients in the composite of in-hospital mortality and major complications, with an estimated odds ratio across the outcome components (average relative effect) of 1.20 (95% confidence interval 0.77-1.87) for physicians vs. non-physicians, P = 0.41. There was also no difference in the risk of re-operation or duration of hospitalization.
A variety of important outcomes were similar in physician patients and matched non-physician patients after non-cardiac surgery.
当医生成为患者时，他们可能期望获得特殊待遇、护理人员给予额外关注以及接受非常规治疗。因此，医生患者可能不会按照常规方式接受治疗，这可能会使护理质量恶化而非改善。因此，我们检验了主要假设，即非心脏手术后住院死亡率和主要并发症在医生患者中比在非医生患者中更常见。
提取了2005年至2013年在克利夫兰诊所接受非心脏手术患者的围手术期数据。我们使用倾向评分匹配来确定医生患者和非医生患者的可比组。使用广义方程平均相对效应模型，对匹配的医生患者和非医生患者在住院死亡率和主要术后并发症的综合情况进行比较。其次，还使用逻辑回归对匹配患者的再次手术情况进行比较，并使用对数秩检验和Cox比例风险回归的Kaplan-Meier分析对住院时间进行比较。
在21173名符合条件的患者中，我们将522名医生患者与2448名非医生对照进行了匹配。医生患者和非医生患者在住院死亡率和主要并发症的综合情况方面没有显著差异，医生与非医生在各个结局指标上的估计比值比（平均相对效应）为1.20（95%置信区间0.77 - 1.87），P = 0.41。再次手术风险或住院时间也没有差异。
非心脏手术后，医生患者和匹配的非医生患者在各种重要结局方面相似。
