O'Connor G T, Birkmeyer J D, Dacey L J, Quinton H B, Marrin C A, Birkmeyer N J, Morton J R, Leavitt B J, Maloney C T, Hernandez F, Clough R A, Nugent W C, Olmstead E M, Charlesworth D C, Plume S K
Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA. gerald.t.o'
Ann Thorac Surg. 1998 Oct;66(4):1323-8. doi: 10.1016/s0003-4975(98)00762-0.
It is well known that surgeon-specific in-hospital mortality rates for coronary artery bypass grafting vary, but this aggregate measure does not suggest specific opportunities for improvement.
We performed a regional prospective study of 8,641 consecutive patients undergoing isolated coronary artery bypass grafting by all of the 23 cardiothoracic surgeons practicing in northern New England during the study period. Mode of death was assigned by an end points committee using predetermined definitions. Surgeons were ranked according to risk-adjusted mortality rates and grouped in terciles, and cause-specific mortality rates were determined.
The mortality rate was 3.3% in the lowest surgeon mortality tercile and 5.8% in the highest tercile. Fatal heart failure accounted for 80.0% of the difference in aggregate mortality rates, ranging from 1.9% in lowest surgeon mortality tercile to 4.0% in the highest tercile (p < 0.001). Rates of other causes did not differ significantly across surgeon mortality terciles. Differences in rates of fatal heart failure could not be explained by differences in preoperative left ventricular dysfunction or other patient characteristics.
Most of the difference in observed mortality rates across surgeons is attributable to differences in rates of heart failure.
众所周知，冠状动脉搭桥手术中外科医生的院内死亡率存在差异，但这一总体指标并未表明具体的改进机会。
我们对研究期间在新英格兰北部执业的23位心胸外科医生连续进行的8641例单纯冠状动脉搭桥手术患者进行了一项区域性前瞻性研究。死亡方式由一个终点委员会根据预先确定的定义进行判定。根据风险调整后的死亡率对外科医生进行排名，并分为三分位数组，然后确定特定病因的死亡率。
外科医生死亡率最低的三分位数组死亡率为3.3%，最高的三分位数组为5.8%。致命性心力衰竭占总死亡率差异的80.0%，从外科医生死亡率最低的三分位数组的1.9%到最高的三分位数组的4.0%（p<0.001）。其他病因的发生率在外科医生死亡率三分位数组之间没有显著差异。致命性心力衰竭发生率的差异无法用术前左心室功能障碍或其他患者特征的差异来解释。
观察到的外科医生之间死亡率的差异大部分归因于心力衰竭发生率的差异。
