2016-2023年军队医疗设施急诊普外科业务量变化分析

IF 1.1 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL
Kyle Patrick Apilado, Kevin Chuang, Jacob H Cole, Christian L Coles, Andrew J Schoenfeld, Tracey Perez Koehlmoos
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引用次数: 0

摘要

背景:急诊普通外科(EGS)手术是至关重要和高风险的干预措施。在军事治疗设施(mtf)提供这些程序对美国军事卫生系统(MHS)的受益者很重要。在2019冠状病毒病大流行的情况下,组织变革,包括国防卫生机构下mtf的整合和人员裁减,引发了对护理质量可能下降的担忧。我们评估了临床结果是否保持一致或受到医疗管理变化和COVID-19大流行的负面影响。材料和方法:使用来自MHS数据库和ICD-10诊断代码的索赔数据来识别2016年至2023财政年度期间入住美国MTFs的18-64岁EGS患者。主要预测因子是医院EGS容积,按容积四分位数分类。结果为30天死亡率、并发症和再入院。根据指标入院日期将患者分为2016-2019财年和2020-2023财年2个时间段。采用多变量logistic回归模型评估MTF体积与临床结果之间的关系。结果:在40个MTFs中确定了113,626例EGS遭遇。调整后的分析显示,与2016-2019年最高交易量的mtf相比,2016-2019年中下四分位数(LMQ)和中上四分位数(UMQ)的mtf (OR: 0.67;OR: 0.67)和2020-2023年的LMQ (OR: 0.70)显著降低了30天死亡率的可能性。与2016-2019年最高容量MTFs相比,2016-2019年最低容量MTFs出现并发症的可能性显著降低(OR: 0.67),而2016-2019年UMQ (OR: 1.10)和2020-2023年所有四分位数的MTFs (OR: 1.22;OR: 1.61;OR: 1.43;OR: 1.27)更容易出现并发症。2016-2019年LMQ和UMQ MTFs治疗的患者(OR: 0.78;OR: 0.70)和2020-2023年最低和中四分位数(OR: 0.67;OR: 0.71;OR: 0.76)与2016-2019年最高数量的mtf相比,再入院的可能性显着降低。结论:与2016-2019年MTF相比,2020-2023年所有MTF四分位数中30天并发症的可能性显著增加。然而,与接受大容量MTFs治疗的患者相比,接受小容量MTFs治疗的EGS患者的死亡率和再入院率的临床结果即使没有改善,也是相似的。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Changes in Emergency General Surgery Volume Within Military Treatment Facilities (2016-2023).

Background: Emergency General Surgery (EGS) procedures are vital and high-risk interventions. Delivery of these procedures in military treatment facilities (MTFs) is important to beneficiaries of the U.S. Military Health System (MHS). Organizational changes, including consolidation of MTFs under the Defense Health Agency and personnel reductions, in conjunction with the COVID-19 pandemic, have led to concerns about potential declines in care quality. We assessed whether clinical outcomes remained consistent or were negatively influenced by the healthcare administrative changes and the COVID-19 pandemic.

Materials and methods: Claims data from the MHS Data Repository and ICD-10 diagnosis codes were used to identify patients, 18-64, admitted to U.S.-based MTFs between fiscal years 2016 and 2023 with an EGS condition. The main predictor was hospital EGS volume categorized into volume-based quartiles. Outcomes were 30-day mortality, complications, and readmissions. Patients were stratified into 2 time periods (FY 2016-2019 and FY 2020-2023) based on index admission date. Multivariable logistic regression models were used to assess the relationship between MTF volume and clinical outcomes.

Results: 113,626 EGS encounters treated across 40 MTFs were identified. Adjusted analyses showed that compared to the highest volume MTFs of 2016-2019, MTFs in the lower middle quartiles (LMQ) and upper middle quartiles (UMQ) of 2016-2019 (OR: 0.67; OR: 0.67) and LMQ of 2020-2023 (OR: 0.70) had a significantly decreased likelihood of 30-day mortality. Compared to 2016-2019's highest volume MTFs, the lowest volume MTFs of 2016-2019 were significantly less likely to experience complications (OR: 0.67), while MTFs from the UMQ of 2016-2019 (OR: 1.10) and all quartiles of 2020-2023 (OR: 1.22; OR: 1.61; OR: 1.43; OR: 1.27) were significantly more likely to develop complications. Patients treated at MTFs in the LMQ and UMQ of 2016-2019 (OR: 0.78; OR: 0.70) and those in the lowest and middle quartiles of 2020-2023 (OR: 0.67; OR: 0.71; OR: 0.76) had a significantly lower likelihoods of readmission compared to the highest volume MTFs of 2016-2019.

Conclusion: The likelihood of 30-day complications among all MTF quartiles in 2020-2023 was significantly higher compared to MTFs in 2016-2019. However, EGS patients treated in low-volume MTFs experienced similar, if not improved, clinical outcomes of mortality and readmissions compared to those treated in high-volume MTFs.

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来源期刊
Military Medicine
Military Medicine MEDICINE, GENERAL & INTERNAL-
CiteScore
2.20
自引率
8.30%
发文量
393
审稿时长
4-8 weeks
期刊介绍: Military Medicine is the official international journal of AMSUS. Articles published in the journal are peer-reviewed scientific papers, case reports, and editorials. The journal also publishes letters to the editor. The objective of the journal is to promote awareness of federal medicine by providing a forum for responsible discussion of common ideas and problems relevant to federal healthcare. Its mission is: To increase healthcare education by providing scientific and other information to its readers; to facilitate communication; and to offer a prestige publication for members’ writings.
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