医院规模越小,斯坦福 A 型主动脉夹层的死亡率越高。

Vascular and endovascular surgery Pub Date : 2025-01-01 Epub Date: 2024-08-26 DOI:10.1177/15385744241278839
Renxi Li, Qianyun Luo, Derrick Green, Stephen Huddleston
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引用次数: 0

摘要

背景:斯坦福A型主动脉夹层(TAAD)与高院内死亡率和需要立即手术干预有关。医院规模越大,患者护理和手术效果越好。本研究旨在探讨医院规模对 TAAD 治疗效果的影响:在2015-2020年第四季度的全国住院患者样本(NIS)中确定了接受TAAD修复手术的患者。NIS根据医院床位数、地理位置和教学地位将医院规模分为小型、中型和大型医院。在小型/中型医院和大型医院住院的患者被分为两个队列。在对人口统计学、合并症、主要付款人状况和包括手术量在内的医院特征进行调整后,进行多变量逻辑回归以比较住院结果:小型/中型医院和大型医院分别收治了1106名和3752名TAAD患者。与大型医院相比,小型/中型医院收治的患者死亡率更高(17.27% vs 14.37%,aOR = 1.32,P < 0.01),但住院时间更短(P < 0.01),费用更低(P = 0.03)。在发病率方面没有差异:结论:TAAD患者入住规模较小的医院死亡率明显较高,这反过来可能会减少平均住院时间和费用。鉴于相当大比例的患者已被转出最初的医院,而中小型医院与较高的死亡率相关,因此在卓越中心集中治疗可能会降低与 TAAD 相关的高死亡率。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Smaller Hospital Size is Associated With Higher Mortality in Stanford Type A Aortic Dissection.

Background: Stanford Type A Aortic Dissection (TAAD) is associated with high in-hospital mortality and the need for immediate surgical intervention. Larger hospital size may be associated with better patient care and surgical outcomes. This study aimed to examine the effect of hospital size on TAAD outcomes.

Method: Patients who underwent TAAD repair were identified in National Inpatient Sample (NIS) from Q4 2015-2020. NIS stratifies hospital size into small, medium, and large based on the number of hospital beds, geographical location, and the teaching status of the hospitals. Patients admitted to small/medium and large hospitals were stratified into two cohorts. Multivariable logistic regressions were performed to compare in-hospital outcomes, adjusted for demographics, comorbidity, primary payer status, and hospital characteristics including procedural volume.

Results: There were 1106 and 3752 TAAD admitted to small/medium and large hospitals, respectively. Among patients admitted to small/medium hospitals, there was higher mortality (17.27% vs 14.37%, aOR = 1.32, P < 0.01), but shorter length of stay (P < 0.01) and lower cost (P = 0.03) compared to larger hospitals. There was no difference in morbidities.

Conclusions: Marked higher mortality is associated with admission to smaller hospitals among patients with TAAD, which may in turn decrease the average hospital stay and cost. Given that a significant percentage of patients are already being transferred out of the initial hospital and small/medium hospital is associated with higher mortality, centralization of care in centers of excellence may decrease the high mortality associated with TAAD.

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