日本医院手术死亡率和抢救失败率低的要求

IF 2.9 4区 医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Annals of Gastroenterological Surgery Pub Date : 2023-10-16 DOI:10.1002/ags3.12745
Itaru Endo, Arata Takahashi, Hisateru Tachimori, Hiroaki Miyata, Yuki Homma, Takafumi Kumamoto, Ryusei Matsuyama, Yoshihiro Kakeji, Yuko Kitagawa, Yasuyuki Seto
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引用次数: 0

摘要

目的 我们探讨了日本八种主要胃肠道手术中与较低手术死亡率和抢救失败率(FTR)相关的机构因素。 方法 向 2119 个机构部门(ID)发送了一份包含 22 个项目的在线问卷,以研究机构因素与手术死亡率和抢救失败率之间的关联。根据年度手术数量、委员会认证状况和地区对科室进行了分类。此外,还根据FTR率确定了前20%和后20%的ID,并与问卷调查结果进行了比对。通过多变量分析筛选出与手术死亡率相关的因素。 结果 在回复问卷的 1083 家 ID 中,有 568 家(213 382 名患者)被纳入分析范围。排名前 20% 和后 20% 的 ID 的手术发病率、手术死亡率和 FTR 率分别为 13.1% 和 8.4% (p <0.001)、0.52% 和 4.3% (p <0.001)、4.0% 和 51.2% (p <0.001)。根据患者的背景特征,排名前 20% 的 ID 处理了更多的晚期病例。较好或较差医院的 FTR 率在地区上没有明显差异,但人口稀少地区的食管切除术、肝切除术和胰十二指肠切除术较少。通过多变量逻辑分析发现,有六个项目与手术死亡率有关。只有 50 个(8.8%)ID 符合与更好的 FTR 率相关的所有五个因素。 结论 本研究结果表明,以人力资源丰富为特点的外科治疗周围的几个医院因素与术后严重并发症的恢复密切相关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。

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Requirements for hospitals in Japan to have low operative mortality and failure-to-rescue rates

Aim

We explored institutional factors in Japan associated with lower operative mortality and failure-to-rescue (FTR) rates for eight major gastrointestinal procedures.

Methods

A 22-item online questionnaire was sent to 2119 institutional departments (IDs) to examine the association between institutional factors and operative mortality and FTR rates. IDs were classified according to the number of annual surgeries, board certification status, and locality. In addition, the top 20% and bottom 20% of IDs were identified based on FTR rates and matched with the results of the questionnaire survey. Factors associated with operative mortality were selected by multivariate analysis.

Results

Of the 1083 IDs that responded to the questionnaire, 568 (213 382 patients) were included in the analysis. Operative morbidity, operative mortality, and FTR rates in the top 20% and bottom 20% of IDs were 13.1% and 8.4% (p < 0.001), 0.52% and 4.3% (p < 0.001), and 4.0% and 51.2% (p < 0.001), respectively. Based on the patients' background characteristics, the top 20% of IDs handled more advanced cases. No significant difference in locality was seen between better or worse hospital FTR rates, but fewer esophagectomies, hepatectomies, and pancreatoduodenectomies were performed in depopulated areas. Six items were found to be associated with operative mortality by multivariate logistic analysis. Only 50 (8.8%) IDs met all five factors related to better FTR rates.

Conclusions

The present findings indicate that several hospital factors surrounding surgical treatment, characterized by abundant human resources, are closely related to better postoperative recovery from severe complications.

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来源期刊
Annals of Gastroenterological Surgery
Annals of Gastroenterological Surgery GASTROENTEROLOGY & HEPATOLOGY-
CiteScore
5.30
自引率
11.10%
发文量
98
审稿时长
11 weeks
期刊最新文献
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