Adelaide Medical School, The University of Adelaide, Adelaide, Australia.
Department of Cardiology, The Prince Charles Hospital, Brisbane, Australia; School of Clinical Medicine, The University of Queensland, Brisbane, Australia; Cardiovascular Centre, E Hospital, Hanoi, Viet Nam.
Int J Cardiol. 2022 Sep 1;362:35-41. doi: 10.1016/j.ijcard.2022.04.080. Epub 2022 Apr 30.
Thirty-day mortality following coronary artery bypass grafting (CABG) is a widely accepted marker for quality of care. Although surgical mortality has declined, the utility of this measure to profile quality has not been questioned. We assessed the institutional variation in risk-standardised mortality rates (RSMR) following isolated CABG within Australia and New Zealand (ANZ).
We used an administrative dataset from all public and most private hospitals across ANZ to capture all isolated CABG procedures recorded between 2010 and 2015. The primary outcome was all-cause death occurring in-hospital or within 30-days of discharge. Hospital-specific RSMRs and 95% CI were estimated using a hierarchical generalised linear model accounting for differences in patient characteristics.
Overall, 60,953 patients (mean age 66.1 ± 10.1y, 18.7% female) underwent an isolated CABG across 47 hospitals. The observed early mortality rate was 1.69% (n = 1029) with 81.8% of deaths recorded in-hospital. The risk-adjustment model was developed with good discrimination (C-statistic = 0.81). Following risk-adjustment, a 3.9-fold variation was observed in RSMRs among hospitals (median:1.72%, range:0.84-3.29%). Four hospitals had RSMRs significantly higher than average, and one hospital had RSMR lower than average. When in-hospital mortality alone was considered, the median in-hospital RSMR was 1.40% with a 5.6-fold variation across institutions (range:0.57-3.19%).
Average mortality following isolated CABG is low across ANZ. Nevertheless, in-hospital and 30-day mortality vary among hospitals, highlighting potential disparities in care quality and the enduring usefulness of 30-day mortality as an outcome measure. Clinical and policy interventions, including participating in clinical quality registries, are needed to standardise CABG care.
冠状动脉旁路移植术（CABG）术后 30 天死亡率是评估医疗质量的一个广泛接受的指标。尽管手术死亡率有所下降，但该指标用于评估质量的效用尚未受到质疑。我们评估了澳大利亚和新西兰（ANZ）内孤立性 CABG 术后风险标准化死亡率（RSMR）的机构间差异。
我们使用了来自 ANZ 所有公立和大多数私立医院的行政数据集，以捕获 2010 年至 2015 年期间记录的所有孤立性 CABG 手术。主要结局是住院期间或出院后 30 天内发生的全因死亡。使用分层广义线性模型估计医院特异性 RSMR 和 95%CI，该模型考虑了患者特征的差异。
共有 60953 例患者（平均年龄 66.1±10.1 岁，18.7%为女性）在 47 家医院接受了孤立性 CABG。观察到的早期死亡率为 1.69%（n=1029），81.8%的死亡发生在住院期间。风险调整模型具有良好的判别能力（C 统计量=0.81）。在风险调整后，医院间 RSMR 存在 3.9 倍的差异（中位数：1.72%，范围：0.84-3.29%）。四家医院的 RSMR 明显高于平均值，一家医院的 RSMR 低于平均值。仅考虑住院期间死亡率时，住院期间 RSMR 的中位数为 1.40%，机构间存在 5.6 倍的差异（范围：0.57-3.19%）。
在 ANZ，孤立性 CABG 术后的平均死亡率较低。然而，医院间的住院和 30 天死亡率存在差异，这突出了护理质量的潜在差异，以及 30 天死亡率作为结局指标的持久有用性。需要采取临床和政策干预措施，包括参与临床质量登记处，以标准化 CABG 护理。
