Stremple J F, Bross D S, Davis C L, McDonald G O
Surgical Service, Veterans Health Administration Medical Center, Pittsburgh, Pennsylvania 15240.
J Surg Res. 1994 May;56(5):405-16. doi: 10.1006/jsre.1994.1065.
We compared postoperative mortality and morbidity rates in the Veterans Health Administration (VA) to those in nonfederal hospitals, using multivariate analysis to adjust for the patient characteristics of age, diagnosis, comorbidity, and severity of illness. We used a total of 544,000 patient discharge records (330,000 nonfederal and 214,000 VA) from 1987 through 1988 and compared 118 surgical procedures or procedure groups composed of 314 individual surgical procedures. We found no significant differences in postoperative mortality rates between the VA and nonfederal hospital systems for 110 of 118 surgical procedures or procedure groups. Endarterectomy, cervical esophagostomy, and esophageal anastomosis or esophagocolostomy showed significantly lower postoperative mortality in the VA hospitals compared to nonfederal hospitals (P = 0.05). VA postoperative mortality rates that were higher than those in nonfederal hospitals and could not be entirely explained by adjusting for patient characteristics were found for suture of ulcer, cholecystostomy, colon surgery, small intestine surgery, and reopening of recent thoracotomy site (P = 0.05). Respiratory, gastrointestinal, and urinary postoperative morbidity were generally lower in the VA hospitals than in nonfederal hospitals (P = 0.05). Infections were generally higher in the VA hospitals than in nonfederal hospitals. Pulmonary embolism, deep venous thrombosis, shock due to surgery or anesthesia, mediastinitis, hemorrhage, cardiac, and central nervous system morbidity showed no significant differences. These data demonstrate that VA postoperative mortality and morbidity in 118 surgical procedures or procedure groups is comparable to those in nonfederal hospitals.
我们使用多变量分析来调整患者的年龄、诊断、合并症和疾病严重程度等特征，比较了退伍军人健康管理局（VA）与非联邦医院的术后死亡率和发病率。我们使用了1987年至1988年期间总共544,000份患者出院记录（330,000份非联邦医院记录和214,000份VA记录），并比较了由314种单独外科手术组成的118种外科手术或手术组。我们发现，在118种外科手术或手术组中的110种中，VA和非联邦医院系统之间的术后死亡率没有显著差异。与非联邦医院相比，VA医院的动脉内膜切除术、颈段食管造口术以及食管吻合术或食管结肠吻合术的术后死亡率显著更低（P = 0.05）。对于溃疡缝合术、胆囊造口术、结肠手术、小肠手术以及近期开胸手术部位的再次开放，发现VA的术后死亡率高于非联邦医院，且通过调整患者特征无法完全解释这种差异（P = 0.05）。VA医院的呼吸、胃肠道和泌尿系统术后发病率总体上低于非联邦医院（P = 0.05）。VA医院的感染率总体上高于非联邦医院。肺栓塞、深静脉血栓形成、手术或麻醉引起的休克、纵隔炎、出血、心脏和中枢神经系统发病率没有显著差异。这些数据表明，VA在118种外科手术或手术组中的术后死亡率和发病率与非联邦医院相当。
