A Nationwide Study Assessing Preventable Hospitalization Rate on Mortality After Major Cardiovascular Surgery

被引:3
作者
Chung, Kevin C. [1 ]
Kotsis, Sandra, V [2 ]
Wang, Lu [3 ]
Chen, Jung-Sheng [4 ]
Kuo, Chang-Fu [4 ,5 ]
机构
[1] Michigan Med, Sect Plast Surg, Dept Surg, Ann Arbor, MI USA
[2] Univ Michigan, Dept Surg, Sect Plast Surg, Sch Med, Ann Arbor, MI USA
[3] Univ Michigan, Sch Publ Hlth, Dept Biostat, Ann Arbor, MI 48109 USA
[4] Chang Gung Mem Hosp, Div Rheumatol Allergy & Immunol, 5 Fu Hsing St, Taoyuan 333, Taiwan
[5] Univ Nottingham, Sch Med, Div Rheumatol Orthoped & Dermatol, Nottingham, England
关键词
Preventable hospitalization; Quality; Cardiovascular surgery; Abdominal aortic aneurysm repair; Coronary artery bypass graft; Aortic valve replacement; CORONARY-ARTERY-BYPASS; ABDOMINAL AORTIC-ANEURYSM; VOLUME-OUTCOME RELATIONSHIPS; NEW-YORK-STATE; SURGICAL MORTALITY; REPAIR; ASSOCIATION; SPECIALTY; QUALITY; TAIWAN;
D O I
10.1053/j.semtcvs.2020.05.017
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Despite the use of various factors to measure hospital quality, most measures have not resulted in long-term improvements in patient outcomes. This study's purpose is to determine the effect of a previously unassessed measure of quality of care—a hospital's preventable hospitalization rate—on 30-day mortality at both the hospital and individual levels after three major cardiovascular surgery procedures. This is a population-based study using Taiwan's National Health Insurance database. We retrieved data from 2001 to 2014 for patients who had undergone abdominal aortic aneurysm (AAA) repair, coronary artery bypass graft, or aortic valve replacement (AVR). Preventable hospitalizations are hospitalizations for 11 chronic conditions that are considered preventable with effective primary care. The outcome was 30-day surgical mortality. Our dataset contained 65,863 patients who had undergone surgery for one of the three cardiovascular procedures. Preventable hospitalization rate was significantly associated with higher hospital mortality rates for all procedures. At the patient level, the adjusted odds of mortality after AAA repair were increased 55% (P < 0.01) for every 2% increase in the preventable hospitalization rate. For coronary artery bypass graft, preventable hospitalization was not a significant predictor of mortality, but rather patient factors and surgeon factors were significant. For AVR, the adjusted odds of mortality were increased 7% (P < 0.01) for every 1% increase in preventable hospitalization rate. High preventable hospitalization rate may serve as a hospital quality measure that could signal increased odds of mortality for selected cardiovascular procedures, especially for higher risk-lower volume procedures such as AAA repair and AVR. © 2020 Elsevier Inc.
引用
收藏
页码:95 / 104
页数:10
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