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首页> 外文期刊>The Annals of Thoracic Surgery: Official Journal of the Society of Thoracic Surgeons and the Southern Thoracic Surgical Association >The Effect of Comprehensive Society of Thoracic Surgeons Quality Improvement on Outcomes and Failure to Rescue
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The Effect of Comprehensive Society of Thoracic Surgeons Quality Improvement on Outcomes and Failure to Rescue

机译：胸外科医师综合社会素质提高对结局和抢救失败的影响

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Data SourcePatient PopulationStatistical AnalysisDiscussionReferencesThe Society of Thoracic Surgeons (STS) quality benchmarks guide clinical outcome improvement in cardiac surgery. Failure to rescue (FTR) from postoperative morbidity is a proposed metric of program quality. We examined the effect of a quality improvement initiative guided by STS quality measures on outcomes and FTR.MethodsProspectively collected STS data on 3,065 consecutive patients who underwent nonemergency cardiac operations at a single institution from January 1, 2010, to January 31, 2014, were retrospectively analyzed. On January 1, 2012, the quality improvement initiative was implemented. Clinical outcomes and FTR rates were compared between operations performed before (group A) and after (group B) implementation.ResultsSTS predicted preoperative mortality and composite of mortality plus morbidity were similar in group A and group B (2.9% ± 3.7% vs 3.1% ± 4.0%, p?= 0.21; 17.8% ± 12.1% vs 18.3% ± 12.4%, p?= 0.24, respectively). However, the observed mortality and composite mortality plus morbidity were lower in group B vs group A (31 of 1,576 [2.0%] vs 46 of 1,489 [3.1%], p?= 0.05; 168 of 1,576 [10.7%] vs 301 of 1,489 [20.2%], p?= 0.0001, respectively). Despite clinical outcome improvement, no differences in FTR rates were observed across all seven major morbidity indicators in group A vs B (35 of 290 [12.1%] vs 19 of 156 [12.1%], p?= 1.00, respectively). The finding of similarity in the FTR rate remained consistent during procedural subgroup analysis for isolated coronary artery bypass grafting in group A vs B (22 of 174 [12.6%] vs 9 of 77 [11.7%], p?= 1.00, respectively).ConclusionsImplementation of quality improvement initiatives significantly improves outcomes without affecting FTR rates. Further study is needed to determine if FTR provides additive value to quality assessment over existing STS metrics.There has been an increased interest in the quantification of health care quality. The Society of Thoracic Surgeons (STS) quality benchmarks have proved to be a useful metric for improving adult cardiac surgical outcomes across the United States [
机译：数据来源患者人群统计分析讨论参考文献胸外科医师协会（STS）质量基准可指导心脏外科手术的临床结局改善。术后发病率无法挽救（FTR）是计划质量的一项提议指标。方法我们回顾性收集了2010年1月1日至2014年1月31日在一家机构进行的3,065例接受非紧急心脏手术的连续患者的STS数据，这些数据均以STS质量测量为指导，对结果和FTR进行了回顾性研究。分析。 2012年1月1日，实施了质量改进计划。比较了在A组和B组实施之前和之后的临床结局和FTR率。结果STS预测A组和B组的术前死亡率和死亡率加发病率的复合性相似（2.9％±3.7％vs 3.1％ ±4.0％，p ＝ 0.21; 17.8％±12.1％对18.3％±12.4％，p ＝ 0.24。然而，与A组相比，B组的观察到的死亡率，综合死亡率和发病率更低（分别为1,576 [2.0％]中的31和1,489 [3.1％]中的46，p = 0.05; 1,576 [10.7％]中的168与2002年中的301相比）。 1,489 [20.2％]，p ＝ 0.0001。尽管临床结果有所改善，但A组和B组的所有七个主要发病率指标的FTR率均无差异（分别为290个中的35个[12.1％]和156个中的19个[12.1％]，p = 1.00）。在A组与B组的单独冠状动脉搭桥术的程序亚组分析中，FTR率的相似性保持一致（分别为22个，分别为174个[12.6％]和9个，其中77个[11.7％]，p = 1.00）。结论实施质量改进措施可显着改善结果，而不会影响FTR率。需要进行进一步的研究来确定FTR是否可以在现有STS指标的基础上为质量评估提供附加价值。人们对医疗保健质量量化的兴趣日益浓厚。胸外科医师协会（STS）的质量基准已被证明是改善整个美国成人心脏手术结局的有用指标[

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