JAMA Cardiol:使用90天死亡率vs 30天死亡率作为经导管和外科主动脉瓣置换结局的质量指标

2019-12-21 xiangting MedSci原创

这项研究结果表明,与90天死亡率相比,根据30天死亡率评估医院的表现会低估结局,因此即使经过风险调整,仍会歪曲TAVR和SAVR后的机构表现。

关于30天死亡率是否是了解经导管主动脉瓣置换术TAVR)和外科主动脉瓣置换术(SAVR)后机构实践差异的合理指标,目前仍不清楚。

这项研究探讨了TAVRSAVR30vs 90天死亡率作为死亡率质量指标的效用。

这项全国性多中心队列研究分析了201211日至20151231日接受TAVRSAVR手术的医疗保险受益人的数据。排除同时进行冠脉搭桥术和其他心脏瓣膜或主要开胸手术的患者。排除每年TAVR手术少于50例或SAVR手术少于70例的医院,以确保可靠的估算并减少由于机构样本量小而出现虚假结果的风险。分析了201810月至20198月的数据。

根据医院4年的平均30天死亡率,将其分为高​​10%)、中(80%)、低(10%)组。

分析了90天和1年医院表现等级的变化以及30天、90天死亡率与1年死亡率的相关性。

评估了184家医院的30329 TAVR入院和191家医院的26021 SAVR入院。对于TAVR90天时40家医院(21.7%)的表现等级有变化:高组有13家(48.1%),低组8家(29.6%)。1年后,56家医院(30.4%)等级有变化,其中包括高组21家(77.8%),低组12家(44.4%)。SAVR也观察到类似的结果,总的90天转换率为17.3%,1年转换率为30.3%。调整三组患者风险特征差异后,这些发现仍然存在。在TAVRSAVR之后,捕获90天事件为预测1年结局提供了更有力信息,这在很大程度上是由于90天后观察到瞬时危险出现平台。

这项研究结果表明,与90天死亡率相比,根据30天死亡率评估医院的表现会低估结局,因此即使经过风险调整,仍会歪曲TAVRSAVR后的机构表现。尽管30天死亡率已被验证,但90天死亡率是衡量医院表现和捕获手术相关死亡率更可靠的结局指标。

原始出处:

Sameer Hirji. Utility of 90-Day Mortality vs 30-Day Mortality as a Quality Metric for Transcatheter and Surgical Aortic Valve Replacement Outcomes. JAMA Cardiology. 18 December 2019.

本文系梅斯医学(MedSci)原创编译整理,转载需授权!

 

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    2020-07-20 yxch48
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    2020-05-16 smlt2008
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  6. [GetPortalCommentsPageByObjectIdResponse(id=1782069, encodeId=65311e82069a4, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Wed Jun 10 08:13:00 CST 2020, time=2020-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742659, encodeId=7b331e42659a8, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Mon Jul 20 18:13:00 CST 2020, time=2020-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1977823, encodeId=6e6819e78230f, content=<a href='/topic/show?id=93a211600a' target=_blank style='color:#2F92EE;'>#30天#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1160, encryptionId=93a211600a, topicName=30天)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c39f145, createdName=smlt2008, createdTime=Sat May 16 06:13:00 CST 2020, time=2020-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332693, encodeId=93b113326936f, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Mon Dec 23 09:13:00 CST 2019, time=2019-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415590, encodeId=5ab1141559052, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Mon Dec 23 09:13:00 CST 2019, time=2019-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510266, encodeId=2e8d1510266c7, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Mon Dec 23 09:13:00 CST 2019, time=2019-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035831, encodeId=fdc110358316e, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Dec 21 21:13:00 CST 2019, time=2019-12-21, status=1, ipAttribution=)]
    2019-12-23 lsj631
  7. [GetPortalCommentsPageByObjectIdResponse(id=1782069, encodeId=65311e82069a4, content=<a href='/topic/show?id=5db8409ed8' target=_blank style='color:#2F92EE;'>#Cardiol#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=31, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4097, encryptionId=5db8409ed8, topicName=Cardiol)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=d7532500500, createdName=12499e01m47暂无昵称, createdTime=Wed Jun 10 08:13:00 CST 2020, time=2020-06-10, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1742659, encodeId=7b331e42659a8, content=<a href='/topic/show?id=39cae96626f' target=_blank style='color:#2F92EE;'>#置换#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=25, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=79662, encryptionId=39cae96626f, topicName=置换)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=3a7c35056336, createdName=yxch48, createdTime=Mon Jul 20 18:13:00 CST 2020, time=2020-07-20, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1977823, encodeId=6e6819e78230f, content=<a href='/topic/show?id=93a211600a' target=_blank style='color:#2F92EE;'>#30天#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=27, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1160, encryptionId=93a211600a, topicName=30天)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=c39f145, createdName=smlt2008, createdTime=Sat May 16 06:13:00 CST 2020, time=2020-05-16, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1332693, encodeId=93b113326936f, content=<a href='/topic/show?id=1dd6231822d' target=_blank style='color:#2F92EE;'>#主动脉瓣#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=29, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23182, encryptionId=1dd6231822d, topicName=主动脉瓣)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=dc4b2500077, createdName=hittouch, createdTime=Mon Dec 23 09:13:00 CST 2019, time=2019-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1415590, encodeId=5ab1141559052, content=<a href='/topic/show?id=04812314540' target=_blank style='color:#2F92EE;'>#主动脉#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=33, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=23145, encryptionId=04812314540, topicName=主动脉)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=77603112682, createdName=circumcision, createdTime=Mon Dec 23 09:13:00 CST 2019, time=2019-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1510266, encodeId=2e8d1510266c7, content=<a href='/topic/show?id=e9bce8254ef' target=_blank style='color:#2F92EE;'>#经导管#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=24, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=78254, encryptionId=e9bce8254ef, topicName=经导管)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=93e010191378, createdName=lsj631, createdTime=Mon Dec 23 09:13:00 CST 2019, time=2019-12-23, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1035831, encodeId=fdc110358316e, content=顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=旺医, createdTime=Sat Dec 21 21:13:00 CST 2019, time=2019-12-21, status=1, ipAttribution=)]
    2019-12-21 旺医

    顶刊就是顶刊,谢谢梅斯带来这么高水平的研究报道,我们科里同事经常看梅斯,分享梅斯上的信息

    0

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