Coronary Center, Department of Thoracic and Cardiovascular Surgery, Heart, Vascular, and Thoracic Institute, Cleveland Clinic, Cleveland, Ohio.
Department of Cardiothoracic Surgery, Weill-Cornell Medical College, New York, NY.
J Thorac Cardiovasc Surg. 2023 Sep;166(3):805-815.e1. doi: 10.1016/j.jtcvs.2022.01.051. Epub 2022 Mar 16.
A number of publicly available rating algorithms are used to assess hospital performance in coronary artery bypass grafting (CABG). However, concerns remain that these algorithms fail to correlate with each other and inadequately capture the case complexity of individual center practices.
Composite star ratings for isolated CABG from the Society of Thoracic Surgeons public reporting database were extracted for 2018-2019. U.S. News & World Report Best Hospitals was used to extract CABG ratings as well as overall cardiology and heart surgery ranking, and the Centers for Medicare & Medicaid Services Hospital Compare was used to extract CABG volume and 30-day mortality. Spearman correlation coefficients were used to assess possible relationships. Expert opinion on risk adjustment and program evaluation was incorporated.
Correlations between Society of Thoracic Surgeons star rating and U.S. News & World Report overall ranking in cardiology and heart surgery (r = 0.15) and Centers for Medicare & Medicaid Services 30-day mortality (r = -0.27) were poor. Society of Thoracic Surgeons star rating correlated weakly with U.S. News & World Report CABG ratings (r = 0.33) and with Centers for Medicare & Medicaid Services CABG volume (r = 0.32), whereas the latter 2 correlated moderately (r = 0.52) with each other. Of the 75 centers with accredited cardiac surgery training programs, 13 (17%) did not participate in Society of Thoracic Surgeons public reporting. Important gaps were identified in risk assessment, and potential solutions are proposed.
Correlations between current CABG public reporting systems are weak. Further work is needed to refine and standardize CABG rating systems to more adequately capture the scope and complexity of an individual center's clinical practice and to better inform patients.
目前有许多公开的评分算法可用于评估冠状动脉旁路移植术（CABG）中医院的表现。然而，人们仍然担心这些算法彼此之间没有关联，并且不能充分捕捉个别中心实践的病例复杂性。
从胸外科医师学会（STS）的公开报告数据库中提取 2018-2019 年用于孤立性 CABG 的综合星级评分。《美国新闻与世界报道》最佳医院用于提取 CABG 评分以及整体心脏科和心脏手术排名，而医疗保险和医疗补助服务中心的医院比较用于提取 CABG 量和 30 天死亡率。使用 Spearman 相关系数来评估可能的关系。还纳入了风险调整和计划评估方面的专家意见。
STS 星级评分与《美国新闻与世界报道》在心脏科和心脏手术方面的整体排名（r=0.15）以及医疗保险和医疗补助服务中心 30 天死亡率（r=-0.27）之间的相关性较差。STS 星级评分与《美国新闻与世界报道》的 CABG 评分（r=0.33）和医疗保险和医疗补助服务中心的 CABG 量（r=0.32）相关性较弱，而后两者之间的相关性适中（r=0.52）。在有认证心脏外科培训计划的 75 个中心中，有 13 个（17%）未参与 STS 的公开报告。在风险评估方面发现了重要的差距，并提出了潜在的解决方案。
当前的 CABG 公开报告系统之间的相关性较弱。需要进一步努力改进和标准化 CABG 评分系统，以更充分地捕捉单个中心临床实践的范围和复杂性，并为患者提供更好的信息。
