Edwards F H, Clark R E, Schwartz M
Division of Cardiothoracic Surgery, University of Florida Health Science Center, Jacksonville 32209-6511.
Ann Thorac Surg. 1994 Jan;57(1):12-9. doi: 10.1016/0003-4975(94)90358-1.
The need for accurate risk assessment has become an indispensable element in the practice of cardiac surgery. The Society of Thoracic Surgeons National Cardiac Surgery Database allows subscribing institutions to perform sophisticated patient risk assessment using traditional statistical tools and a newly developed risk model of operative mortality. The database experience with isolated coronary artery bypass grafting has been studied most closely at this point and serves as the basis for this report. The approach to operative risk assessment is presented along with an analysis of important risk factors in the practice of coronary artery surgery from 1980 through 1990. The database contains records of 80,881 patients undergoing coronary artery bypass grafting in numerous institutions from 1980 through 1990. These records were used to conduct a detailed analysis of risk factors associated with coronary operations in this time interval and to present statistical methods used to formulate a risk equation that allows one to predict the probability of operative death. In the course of this decade, there were clearly defined trends showing a statistically significant increase in adverse patient risk factors. The risk model has proven to be a reliable tool for predicting the probability of operative death in an individual patient and may be valuable in both patient counseling and medical decision making. Large multi-institutional databases of this type are key ingredients of modern operative risk assessment. A database containing a broad national experience of this type can represent an aggregate experience that may well approximate a universally accepted standard of care.
准确的风险评估需求已成为心脏外科手术实践中不可或缺的要素。胸外科医师协会国家心脏外科手术数据库使参与的机构能够使用传统统计工具和新开发的手术死亡率风险模型进行复杂的患者风险评估。目前，对单纯冠状动脉旁路移植术的数据库经验进行了最深入的研究，并作为本报告的基础。本文介绍了手术风险评估方法，并分析了1980年至1990年冠状动脉手术实践中的重要风险因素。该数据库包含了1980年至1990年众多机构中80881例接受冠状动脉旁路移植术患者的记录。这些记录用于详细分析该时间段内与冠状动脉手术相关的风险因素，并介绍用于制定风险方程的统计方法，该方程可用于预测手术死亡的概率。在这十年间，出现了明确的趋势，显示患者不良风险因素在统计学上显著增加。该风险模型已被证明是预测个体患者手术死亡概率的可靠工具，在患者咨询和医疗决策中可能都很有价值。这种大型多机构数据库是现代手术风险评估的关键要素。包含此类广泛全国经验的数据库可以代表一种总体经验，很可能接近普遍接受的护理标准。
