Application of Risk Adjustment in Comparison for Outcomes Among Different Surgical Teams in Patients With Isolated Coronary Artery Bypass Grafting
10.3969/j.issn.1000-3614.2017.12.009
- VernacularTitle:风险校正法在不同手术团队单纯冠状动脉旁路移植术结局比较中的应用
- Author:
lin Xiao DIAO
1
;
Zhe ZHENG
;
Wei ZHAO
;
Xue ZHANG
Author Information
1. 中国医学科学院 北京协和医学院 国家心血管病中心 阜外医院 信息中心
- Keywords:
Cardiac surgical team;
Risk adjustment;
Quality assessment
- From:
Chinese Circulation Journal
2017;32(12):1177-1180
- CountryChina
- Language:Chinese
-
Abstract:
Objective: To assess the quality of isolated coronary artery bypass grafting (CABG) in order to provide the decision support for medical quality management. Methods: Clinical information for adult patients who received CABG in our hospital during 2014 was collected. End point events were defined by major complications and mortality within 30 days after the operation. Taking SinoSCORE as risk variables, hierarchical Logistic regression model was conducted to make risk adjustment, Bootstrap method was used for simulation, we obtained RSMCR (risk-standardized major complication rate) and 95%CI. Results: There were 138/3785 (3.65%) patients with single CABG suffered from end point events.The range of un-adjusted end point events was (2.53%-6.09%) among 9 surgical teams (units), pre-operative risk condition was different among 9 units, SinoSCORE showed P<0.05 and with risk adjustment,the range of RSMCRs was(3.12%-4.82%); after Bootstrap simulation, one unit had the upper limit of RSMCR 95%CI(2.85%-3.61%) which was lower than the average and another unit had the lower limit of RSMCR 95%CI (3.81%-5.40%) which was higher than the average, RSMCR in the rest 7 units was similar. Conclusion: We made an objective evaluation for surgery quality in 9 adult care units by risk adjustment method andprovided a decision-making basis for improving medical quality management.
