Rogers Michael P, Janjua Haroon M, Kuo Paul C
Department of Surgery, University of South Florida Morsani College of Medicine, Tampa, FL.
Surg Open Sci. 2022 May 20;10:1-6. doi: 10.1016/j.sopen.2022.05.010. eCollection 2022 Oct.
High-volume surgeons and hospitals performing coronary artery bypass grafting have been associated with improved patient outcomes. However, patients of increased socioeconomic distress may have worse outcomes because of health care disparities. We sought to identify trends and outcomes in patients of elevated distress undergoing bypass grafting.
The Florida Agency for Healthcare Administration administrative data set was merged with Centers for Medicare and Medicaid Services Physician and Hospital Compare and Economic Innovation Group Distressed Community Index data sets to build a comprehensive database. The data set was queried to identify patients undergoing coronary artery bypass procedures between 2016 and 2020. High- and low-volume hospitals and surgeons were compared. Patient and hospital demographics, comorbidities, length of stay, and postoperative complications were analyzed by and test where appropriate.
A total of 41,571 coronary artery bypass grafting procedures were performed by 174 surgeons at 67 Florida hospitals. Low- and high-volume hospitals did not differ with respect to hospital ownership, overall star rating, national comparisons of mortality, readmission, or cost effectiveness. Patients from at-risk and distressed communities were more likely to undergo surgery at low-volume hospitals. Hospital length of stay was increased for low-volume hospitals (10.2 vs 9.4 days, P < .05). Postoperative complications including pneumonia, arrhythmia, respiratory failure, acute renal failure, shock, pleural effusion, and sepsis were more frequent at low-volume hospitals and for low-volume surgeons.
High-volume hospitals and surgeons have improved postoperative outcomes and hospital length of stay when compared to low-volume hospitals and surgeons performing coronary artery bypass grafting. At-risk and distressed populations are more likely to undergo bypass surgery at low-volume hospitals, potentially contributing to worse patient outcome. Efforts should be made to mitigate the potential impact of low socioeconomic status to improve outcomes in this population.
进行冠状动脉旁路移植术的高手术量外科医生和医院与患者预后改善相关。然而，社会经济困境加剧的患者可能因医疗保健差距而有更差的预后。我们试图确定接受旁路移植术的困境加剧患者的趋势和预后。
将佛罗里达医疗管理局的行政数据集与医疗保险和医疗补助服务中心的医生和医院比较数据集以及经济创新集团困境社区指数数据集合并，以建立一个综合数据库。查询该数据集以识别2016年至2020年间接受冠状动脉旁路手术的患者。比较了高手术量和低手术量的医院及外科医生。在适当情况下，通过 和 检验分析患者和医院的人口统计学、合并症、住院时间和术后并发症。
佛罗里达67家医院的174名外科医生共进行了41571例冠状动脉旁路移植手术。低手术量和高手术量医院在医院所有权、总体星级评级、死亡率、再入院率或成本效益的全国比较方面没有差异。来自高危和困境社区的患者更有可能在低手术量医院接受手术。低手术量医院的住院时间延长（10.2天对9.4天，P<0.05）。低手术量医院和低手术量外科医生的术后并发症包括肺炎、心律失常、呼吸衰竭、急性肾衰竭、休克、胸腔积液和败血症更为常见。
与进行冠状动脉旁路移植术的低手术量医院和外科医生相比，高手术量医院和外科医生改善了术后预后和住院时间。高危和困境人群更有可能在低手术量医院接受旁路手术，这可能导致患者预后更差。应努力减轻社会经济地位低下的潜在影响，以改善该人群的预后。
