安大略省北部与安大略省南部接受普通中高风险择期手术患者的术后效果:一项基于人群的队列研究。

IF 3.4 3区 医学 Q1 ANESTHESIOLOGY
Max Chen, Kaitlin Duncan, Robert Talarico, Sarah McIsaac, Daniel I McIsaac
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引用次数: 0

摘要

目的:与安大略省南部的居民相比,安大略省北部的居民在健康方面存在多种差异。目前尚不清楚这是否会导致手术结果的差异。我们试图比较安大略省北部和南部患者的术后效果:我们使用关联的行政医疗保健数据开展了一项基于人群的回顾性队列研究,以确定 2009 年至 2022 年期间在加拿大安大略省接受选定的中高风险非心脏手术的所有成年患者。主要结果是手术后 30 天的死亡率。次要结果是在家存活天数、住院时间、医疗保健系统总成本、出院处置和再入院情况。我们使用回归模型来估算暴露与结果之间的调整关联:这项研究确定了 562,115 名患者,其中 41,191 人(7.3%)来自北安大略省。我们没有发现强有力的证据表明安大略省北部居民的死亡率高于安大略省南部居民(调整后的几率比为 1.04;95% 置信区间 [CI],0.85 至 1.27)。安大略省北部居民在30天[调整后的均值比(RoM)为0.92;95% CI为0.89至0.96]和365天[调整后的均值比(RoM)为0.93;95% CI为0.90至0.96]时的医疗系统成本较低。北安大略居民的住院时间更长(调整后的RoM为1.06;95% CI为1.01至1.11)。两组居民在家中存活的天数和再入院率没有统计学差异:北安大略居住地与中高风险择期非心脏手术后死亡率的增加无关。总体而言,我们发现北安大略省和南安大略省的患者在术后结果方面没有临床意义上的差异。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Postoperative outcomes among Northern versus Southern Ontario patients undergoing common intermediate- to high-risk elective surgeries: a population-based cohort study.

Purpose: Northern Ontario residents experience multiple health disparities compared with those in Southern Ontario. It is unknown whether this leads to differences in surgical outcomes. We sought to compare postoperative outcomes of patients from Northern and Southern Ontario.

Methods: We conducted a retrospective population-based cohort study using linked administrative health care data to identify all adult patients undergoing selected elective intermediate- to high-risk noncardiac surgeries in Ontario, Canada between 2009 and 2022. The primary outcome was 30-day mortality following surgery. The secondary outcomes were number of days alive at home, hospital length of stay, total health care system costs, discharge disposition, and readmissions. We used regression models to estimate the adjusted association between the exposure and outcomes.

Results: This study identified 562,115 patients, including 41,191 (7.3%) from Northern Ontario. We did not find strong evidence that mortality rates were higher for Northern vs Southern Ontario residents (adjusted odds ratio, 1.04; 95% confidence interval [CI], 0.85 to 1.27). Health system costs were lower for Northern Ontario residents at 30 days [adjusted ratio of mean (RoM), 0.92; 95% CI, 0.89 to 0.96] and at 365 days (adjusted RoM, 0.93; 95% CI, 0.90 to 0.96). Hospital length of stay was longer for Northern Ontario residents (adjusted RoM, 1.06; 95% CI, 1.01 to 1.11). The number of days alive at home and rate of readmission were not statistically different between the two groups.

Conclusion: Northern Ontario residency was not associated with increased odds of mortality after intermediate- to high-risk elective noncardiac surgery. Overall, we found no clinically meaningful differences in postoperative outcomes between patients from Northern and Southern Ontario.

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来源期刊
CiteScore
8.50
自引率
7.10%
发文量
161
审稿时长
6-12 weeks
期刊介绍: The Canadian Journal of Anesthesia (the Journal) is owned by the Canadian Anesthesiologists’ Society and is published by Springer Science + Business Media, LLM (New York). From the first year of publication in 1954, the international exposure of the Journal has broadened considerably, with articles now received from over 50 countries. The Journal is published monthly, and has an impact Factor (mean journal citation frequency) of 2.127 (in 2012). Article types consist of invited editorials, reports of original investigations (clinical and basic sciences articles), case reports/case series, review articles, systematic reviews, accredited continuing professional development (CPD) modules, and Letters to the Editor. The editorial content, according to the mission statement, spans the fields of anesthesia, acute and chronic pain, perioperative medicine and critical care. In addition, the Journal publishes practice guidelines and standards articles relevant to clinicians. Articles are published either in English or in French, according to the language of submission.
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