评价手术团队熟悉程度对心脏手术结果的影响：一项针对 Medicare 受益人的回顾性队列研究。

Evaluating the Impact of Operative Team Familiarity on Cardiac Surgery Outcomes: A Retrospective Cohort Study of Medicare Beneficiaries.

机构信息

Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.

Center for Surgery and Public Health, Boston, MA.

出版信息

Ann Surg. 2024 May 1;279(5):891-899. doi: 10.1097/SLA.0000000000006100. Epub 2023 Sep 27.

DOI:10.1097/SLA.0000000000006100

PMID:37753657

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10965508/

Abstract

OBJECTIVE

To associate surgeon-anesthesiologist team familiarity (TF) with cardiac surgery outcomes.

BACKGROUND

TF, a measure of repeated team member collaborations, has been associated with improved operative efficiency; however, examination of its relationship to clinical outcomes has been limited.

METHODS

This retrospective cohort study included Medicare beneficiaries undergoing coronary artery bypass grafting (CABG), surgical aortic valve replacement (SAVR), or both (CABG+SAVR) between January 1, 2017, and September 30, 2018. TF was defined as the number of shared procedures between the cardiac surgeon and anesthesiologist within 6 months of each operation. Primary outcomes were 30- and 90-day mortality, composite morbidity, and 30-day mortality or composite morbidity, assessed before and after risk adjustment using multivariable logistic regression.

RESULTS

The cohort included 113,020 patients (84,397 CABG; 15,939 SAVR; 12,684 CABG+SAVR). Surgeon-anesthesiologist dyads in the highest [31631 patients, TF median (interquartile range)=8 (6, 11)] and lowest [44,307 patients, TF=0 (0, 1)] TF terciles were termed familiar and unfamiliar, respectively. The rates of observed outcomes were lower among familiar versus unfamiliar teams: 30-day mortality (2.8% vs 3.1%, P =0.001), 90-day mortality (4.2% vs 4.5%, P =0.023), composite morbidity (57.4% vs 60.6%, P <0.001), and 30-day mortality or composite morbidity (57.9% vs 61.1%, P <0.001). Familiar teams had lower overall risk-adjusted odds of 30-day mortality or composite morbidity [adjusted odds ratio (aOR) 0.894 (0.868, 0.922), P <0.001], and for SAVR significantly lower 30-day mortality [aOR 0.724 (0.547, 0.959), P =0.024], 90-day mortality [aOR 0.779 (0.620, 0.978), P =0.031], and 30-day mortality or composite morbidity [aOR 0.856 (0.791, 0.927), P <0.001].

CONCLUSIONS

Given its relationship with improved 30-day cardiac surgical outcomes, increasing TF should be considered among strategies to advance patient outcomes.

摘要

目的

探讨外科医生-麻醉师团队熟悉程度与心脏手术结果的关系。

背景

团队熟悉程度是衡量团队成员重复协作的指标，它与手术效率的提高有关；然而，其与临床结果的关系仍有待检验。

方法

本回顾性队列研究纳入了 2017 年 1 月 1 日至 2018 年 9 月 30 日期间接受冠状动脉旁路移植术（CABG）、心脏主动脉瓣置换术（SAVR）或二者联合治疗（CABG+SAVR）的 Medicare 受益患者。在每次手术前 6 个月内，将心脏外科医生和麻醉师之间共享的手术次数定义为团队熟悉程度（TF）。主要结局为 30 天和 90 天死亡率、复合发病率和 30 天死亡率或复合发病率，使用多变量逻辑回归在风险调整前后进行评估。

结果

该队列纳入了 113020 例患者（84397 例 CABG；15939 例 SAVR；12684 例 CABG+SAVR）。外科医生-麻醉师配对中，TF 最高[31631 例，TF 中位数（四分位距）=8（6，11）]和最低[44307 例，TF=0（0，1）]的三分位数分别称为熟悉和不熟悉。与不熟悉的团队相比，熟悉的团队观察到的结局发生率更低：30 天死亡率（2.8% vs. 3.1%，P=0.001）、90 天死亡率（4.2% vs. 4.5%，P=0.023）、复合发病率（57.4% vs. 60.6%，P<0.001）和 30 天死亡率或复合发病率（57.9% vs. 61.1%，P<0.001）。熟悉的团队 30 天死亡率或复合发病率的总体风险调整后比值比（aOR）显著降低[调整比值比（aOR）0.894（0.868，0.922），P<0.001]，且 SAVR 术后 30 天死亡率[aOR 0.724（0.547，0.959），P=0.024]、90 天死亡率[aOR 0.779（0.620，0.978），P=0.031]和 30 天死亡率或复合发病率[aOR 0.856（0.791，0.927），P<0.001]的风险也显著降低。