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【 J Thorac Cardiovasc Surg】从1988年到2005年美国的冠状动脉架桥移植术的质量和成本效益不断升高

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楼主 achates
achates
乳腺外科

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这个帖子发布于12年零0天前，其中的信息可能已发生改变或有所发展。
The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 1, January 2009, Pages 60-64

Improved quality and cost-effectiveness of coronary artery bypass grafting in the United States from 1988 to 2005

Objective
This study was undertaken to assess the impact of increasing patient complexity and health care cost on coronary artery bypass grafting quality and cost-effectiveness in the United States over an 18-year period.

Methods
A retrospective study was carried out utilizing the Nationwide Inpatient Sample to track the characteristics and outcomes of 5,549,700 patients having isolated coronary artery bypass grafting in the United States from 1988 to 2005. Expected mortality, risk-adjusted mortality, and hospital charges were tracked over this period.

Results
The prevalence of congestive heart failure, pulmonary disease, diabetes, and acute myocardial infarction increased significantly over the study period. Expected mortality increased from 2.57% to 3.66%, reflecting the increasing patient comorbidity burden (P < .0001). Despite this, coronary artery bypass grafting outcomes improved, leading to a decrease in risk-adjusted mortality from 6.20% to 2.12% (P < .0001). Furthermore, when hospital charges were corrected for medical care inflation, hospital charges declined significantly, from $26,210 in 1988 to $19,196 in 2005 (1988 dollars, P < .0001).

Conclusions
Coronary artery bypass grafting surgery is being performed on an increasingly complex, high-risk patient population in the United States. Despite this challenge, risk-adjusted operative mortality has progressively declined. Moreover, hospital charges for coronary artery bypass grafting in relation to other medical care services have been reduced. These findings reflect improved quality and cost-effectiveness of coronary artery bypass grafting in the United States. Ongoing efforts directed at quality improvement should address the risks associated with comorbidities that increasingly accompany the diagnosis of coronary artery disease in patients having coronary artery bypass grafting.
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The Journal of Thoracic and Cardiovascular Surgery
Volume 137, Issue 1, January 2009, Pages 60-64

Improved quality and cost-effectiveness of coronary artery bypass grafting in the United States from 1988 to 2005
从1988年到2005年美国的冠状动脉架桥移植术的质量和成本效益不断升高

Objective
This study was undertaken to assess the impact of increasing patient complexity and health care cost on coronary artery bypass grafting quality and cost-effectiveness in the United States over an 18-year period.
目的：本研究是试图评价，美国18年以来在冠状动脉架桥移植术方面，逐渐升高的病人的复杂性和健康护理费用对手术质量和成本效益的影响。
Methods
A retrospective study was carried out utilizing the Nationwide Inpatient Sample to track the characteristics and outcomes of 5,549,700 patients having isolated coronary artery bypass grafting in the United States from 1988 to 2005. Expected mortality, risk-adjusted mortality, and hospital charges were tracked over this period.
方法：使用全美住院病人样本库（Nationwide Inpatient Sample）来追踪自1988年至2005年美国国内接受独立的冠状动脉架桥移植术的5549700名病人的特征和预后，从而进行回顾性研究。这段时期的期望死亡率、风险调节的死亡率和住院费用被进行了追踪。
Results
The prevalence of congestive heart failure, pulmonary disease, diabetes, and acute myocardial infarction increased significantly over the study period. Expected mortality increased from 2.57% to 3.66%, reflecting the increasing patient comorbidity burden (P < .0001). Despite this, coronary artery bypass grafting outcomes improved, leading to a decrease in risk-adjusted mortality from 6.20% to 2.12% (P < .0001). Furthermore, when hospital charges were corrected for medical care inflation, hospital charges declined significantly, from $26,210 in 1988 to $19,196 in 2005 (1988 dollars, P < .0001).
结果：在研究的期间内，充血性心衰、肺部疾病、糖尿病和急性心肌梗死的发病率明显增加。期望死亡率由2.57%上升至3.66%，反应了病人增加的合并症负担（P<0.0001）。尽管如此，冠状动脉架桥移植术的预后提高，导致了风险调节的死亡率由6.2%下降至2.12%（P<0.0001）。进一步，当使用医疗保健通货膨胀对住院费用进行矫正后，住院费用大幅下降，从1988年的26.210美元下降至2005年的19.196美元（1998年的美元，P<0.0001）。
Conclusions
Coronary artery bypass grafting surgery is being performed on an increasingly complex, high-risk patient population in the United States. Despite this challenge, risk-adjusted operative mortality has progressively declined. Moreover, hospital charges for coronary artery bypass grafting in relation to other medical care services have been reduced. These findings reflect improved quality and cost-effectiveness of coronary artery bypass grafting in the United States. Ongoing efforts directed at quality improvement should address the risks associated with comorbidities that increasingly accompany the diagnosis of coronary artery disease in patients having coronary artery bypass grafting.
结论：在美国，冠状动脉架桥移植术逐渐用于越来越复杂高风险性的病人群。尽管有这种挑战，调整风险后的手术死亡率已经逐渐的下降了。而且，与其他医疗治疗相比，住院费用也下降了。这些发现反应了在美国冠状动脉架桥移植术的质量和成本效益的提高。直接指向提高质量的努力应该针对解决并发症的风险，这些并发症越来越多的出现在经历了冠状动脉架桥移植术并被诊断为冠状动脉疾病的病人。

从1988年到2005年美国的冠状动脉架桥移植术的质量和成本效益不断升高

目的：本研究是试图评价，美国18年以来在冠状动脉架桥移植术方面，逐渐升高的病人的复杂性和健康护理费用对手术质量和成本效益的影响。

方法：使用全美住院病人样本库（Nationwide Inpatient Sample）来追踪自1988年至2005年美国国内接受独立的冠状动脉架桥移植术的5549700名病人的特征和预后，从而进行回顾性研究。这段时期的期望死亡率、风险调节的死亡率和住院费用被进行了追踪。

结果：在研究的期间内，充血性心衰、肺部疾病、糖尿病和急性心肌梗死的发病率明显增加。期望死亡率由2.57%上升至3.66%，反应了病人增加的合并症负担（P<0.0001）。尽管如此，冠状动脉架桥移植术的预后提高，导致了风险调节的死亡率由6.2%下降至2.12%（P<0.0001）。进一步，当使用医疗保健通货膨胀对住院费用进行矫正后，住院费用大幅下降，从1988年的26.210美元下降至2005年的19.196美元（1998年的美元，P<0.0001）。

结论：在美国，冠状动脉架桥移植术逐渐用于越来越复杂高风险性的病人群。尽管有这种挑战，调整风险后的手术死亡率已经逐渐的下降了。而且，与其他医疗治疗相比，住院费用也下降了。这些发现反应了在美国冠状动脉架桥移植术的质量和成本效益的提高。直接指向提高质量的努力应该针对解决并发症的风险，这些并发症越来越多的出现在经历了冠状动脉架桥移植术并被诊断为冠状动脉疾病的病人。
2009-01-22 12:33
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