Khuri S F, Daley J, Henderson W, Barbour G, Lowry P, Irvin G, Gibbs J, Grover F, Hammermeister K, Stremple J F
Veterans Administration Medical Center, West Roxbury, MA 02132, USA.
J Am Coll Surg. 1995 May;180(5):519-31.
The use of surgical outcome in the comparative assessment of the quality of surgical care is predicted on the development of proper models that adjust for the severity of the preoperative risk factors of the patient. The National Veterans Administration Surgical Risk Study was designed to collect reliable, valid data about patient risk and outcome for major surgery in the Veterans Health Administration (VHA) and to report comparative risk-adjusted surgical morbidity and mortality rates for surgical services in VHA. This study describes the rationale and methods used in the Risk Study and reports on the frequency distribution of the data elements that will be used in the development of risk-adjusted reporting of surgical outcome.
This study was a prospective observational study in which dedicated nurses collected preoperative, intraoperative, and outcome data on patients undergoing noncardiac operations using general, spinal, and epidural anesthesia in 44 Veterans Administration Medical Centers. Outcome measures included all cause mortality within the 30 days after the index procedure and 21 major morbidities.
Eighty-three thousand nine hundred fifty-eight cases meeting inclusion criteria were entered in the study between October 1, 1991 and December 31, 1993. Ninety-seven percent of patients were men, with a mean age of 60.1 +/- 13.6 (standard deviation) years. The most common preoperative risk factors were smoking (40.7 percent) and hypertension (36.1 percent). Of the patients, 84.6 percent had one or more risk factors. The most common procedures were transurethral resection of the prostate gland (6.7 percent), total knee replacement (3.1 percent), thromboendarterectomy (2.4 percent), partial colectomy (2.2 percent), and total hip replacement (2 percent). The unadjusted mortality rate was 3.1 percent at 30 days. The most common postoperative morbidities were pneumonia (3.6 percent), urinary tract infection (3.5 percent), and failure to wean from the ventilator at 48 hours postoperatively (3.2 percent). Seventeen percent of the patients have one or more major complications.
The Veterans Health Administration has successfully implemented an outcome reporting system for major surgery that prospectively collects patient risk and outcome information reliably and validly. Risk adjustment models and comparative hospital-specific rates of risk-adjusted outcomes are currently being developed.
在对外科治疗质量进行比较评估时，手术结果的应用基于合适模型的开发，这些模型可对患者术前危险因素的严重程度进行调整。退伍军人管理局外科风险研究旨在收集退伍军人健康管理局（VHA）中有关大手术患者风险和结果的可靠、有效数据，并报告VHA中各外科服务经过风险调整后的手术发病率和死亡率的比较情况。本研究描述了风险研究中使用的基本原理和方法，并报告了将用于开发手术结果风险调整报告的数据元素的频率分布。
本研究为前瞻性观察性研究，由专业护士收集44家退伍军人管理局医疗中心接受全身麻醉、脊髓麻醉和硬膜外麻醉的非心脏手术患者的术前、术中和结果数据。结果指标包括索引手术术后30天内的全因死亡率和21种主要并发症。
1991年10月1日至1993年12月31日期间，共有83958例符合纳入标准的病例进入研究。97%的患者为男性，平均年龄为60.1±13.6（标准差）岁。最常见的术前危险因素是吸烟（40.7%）和高血压（36.1%）。84.6%的患者有一个或多个危险因素。最常见的手术是经尿道前列腺切除术（6.7%）、全膝关节置换术（3.1%）、血栓内膜切除术（2.4%）、部分结肠切除术（2.2%）和全髋关节置换术（2%）。30天的未调整死亡率为3.1%。最常见的术后并发症是肺炎（3.6%）、尿路感染（3.5%）和术后48小时未能脱机（3.2%）。17%的患者有一个或多个主要并发症。
退伍军人健康管理局已成功实施了一项大手术结果报告系统，该系统前瞻性地可靠且有效地收集患者风险和结果信息。目前正在开发风险调整模型和各医院特定的风险调整结果率。
