Telila Tesfaye, Akintoye Emmanuel, Ando Tomo, Merid Obsinet, Palla Mohan, Mallikethi-Reddy Sagar, Briasoulis Alexandros, Grines Cindy, Afonso Luis
Division of Cardiology, Wayne State University/Detroit Medical center, Detroit, Michigan.
Division of Internal Medicine, Detroit Medical Center, Detroit, Michigan.
Catheter Cardiovasc Interv. 2017 Dec 1;90(7):1200-1205. doi: 10.1002/ccd.27236. Epub 2017 Aug 10.
Evidence suggests that medical service offerings vary by hospital teaching status. However, little is known about how these translate to patient outcomes. We therefore sought to evaluate this gap in knowledge in patients undergoing Transcatheter aortic valve replacement (TAVR) in the United States.
This study was conducted using the National Inpatient Sample (NIS) in the United States from 2011 to 2014. Teaching status was classified, as teaching vs. nonteaching and endpoints were clinical outcomes, length of stay and cost. Procedure-related complications were identified via ICD-9 coding and analysis was performed via mixed effect model.
An estimated 33,790 TAVR procedures were performed in the U.S between 2011 and 2014, out of which 89.3% were in teaching hospitals. Mean (SD) age was 81.4 (8.5) and 47% were females. There was no significant difference between teaching versus nonteaching hospitals in regards to the primary outcome of in-hospital mortality and secondary outcomes of several cardiovascular and other end points except for a high rates of acute kidney injury (AKI) (OR: 1.34 [95% CI, 1.04-1.72]) and lower rate for use of mechanical circulatory support devices in teaching vs. nonteaching centers. The mean length of stay was significantly higher in teaching hospitals (7.7 days) vs. nonteaching hospitals (6.8 days) (P = 0.002) and so was the median cost of hospitalization (USD 50,814 vs. USD 48, 787, P = 0.02) for teaching vs. nonteaching centers.
Most TAVR related short-term outcomes including all cause in-hospital mortality are about the same in teaching and nonteaching hospitals. However, AKI, length of hospital stay and TAVR related cost were significantly higher in teaching than nonteaching hospitals. There was more use of mechanical circulatory support in nonteaching than teaching hospitals.
有证据表明，医疗服务的提供因医院的教学地位而异。然而，对于这些差异如何转化为患者的治疗结果，我们却知之甚少。因此，我们试图评估美国接受经导管主动脉瓣置换术（TAVR）患者在这方面的知识差距。
本研究使用了2011年至2014年美国国家住院样本（NIS）。教学地位分为教学医院与非教学医院，研究终点为临床结局、住院时间和费用。通过ICD-9编码识别与手术相关的并发症，并通过混合效应模型进行分析。
2011年至2014年期间，美国估计进行了33790例TAVR手术，其中89.3%在教学医院进行。平均（标准差）年龄为81.4（8.5）岁，47%为女性。在住院死亡率这一主要结局以及多个心血管和其他终点的次要结局方面，教学医院与非教学医院之间没有显著差异，但教学医院急性肾损伤（AKI）的发生率较高（比值比：1.34 [95%置信区间，1.04 - 1.72]），且教学医院使用机械循环支持设备的比例低于非教学医院。教学医院的平均住院时间（7.7天）显著长于非教学医院（6.8天）（P = 0.002），教学医院的住院费用中位数（50814美元对48787美元，P = 0.02）也高于非教学医院。
教学医院和非教学医院在大多数与TAVR相关的短期结局（包括全因住院死亡率）方面大致相同。然而，教学医院的急性肾损伤发生率、住院时间和TAVR相关费用显著高于非教学医院。非教学医院比教学医院更多地使用机械循环支持。
