【medical-news】冠脉搭桥术：三分之一的死亡是可以避免的
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A third of CABG deaths 'could have been prevented'
11 June 2008
MedWire News: Around one third of coronary artery bypass graft (CABG) deaths at nine Canadian hospitals could have been avoided if the patients had received optimal care, a study reveals.
A substantial number of preventable deaths were identified even where risk-adjusted mortality rates were low, highlighting the limitations of report cards in detecting significant quality-of-care problems.
Veena Guru (Institute for Clinical Evaluative Sciences, Toronto, Canada) and colleagues conducted a retrospective analysis of 347 randomly selected inhospital deaths after isolated CABG surgery at nine institutions in Ontario, Canada, between 1998 and 2003.
Two experienced cardiac surgeons blinded to patients, surgeon, and hospital reviewed hospital charts, summarized by trained nurses, to identify preventable death. A third reviewer reassessed any cases on which the first two disagreed.
In all, the surgeons judged 11 (32%) of the deaths to have been preventable, despite low risk-adjusted inhospital mortality rates ranging from 1.3% to 3.1% across hospitals.
Notwithstanding this narrow range for risk-adjusted mortality, the authors note, there was no correlation between risk-adjusted mortality rates and the proportion of preventable deaths across the nine hospitals. The highest proportion of deaths deemed preventable occurred at a center in the mid-range for risk-adjusted mortality.
Based on institutional volumes, the researchers calculated that as many as 107 potentially preventable CABG-related deaths occurred in Ontario in the fiscal year 2000-2001.
The researchers identified more than one preventable cause for a given preventable death. The majority of preventable deaths were attributed to problems in the operating room (86%) or postoperative intensive care unit (61%), with a minority due to problems on the ward (15%).
A large minority of preventable deaths were associated with deviations in perioperative care (32%).
Harlan Krumholz (Yale University, New Haven, Connecticut, USA) noted in a related editorial that measuring and highlighting problems in the healthcare system requires "increasingly sophisticated approaches to diagnosing the underlying causes of suboptimal performance."
He wrote that the necessary insight "may only be achieved through implicit review of patient records and thoughtful investigation of the details of patient care," and that the current study provides an example of how this approach can best be achieved.
Circulation 2008; 117: 2969-2976
http://www.incirculation.net/NewsItem/A-third-of-CABG-deaths-could-have-been-prevented.aspx
11 June 2008
MedWire News: Around one third of coronary artery bypass graft (CABG) deaths at nine Canadian hospitals could have been avoided if the patients had received optimal care, a study reveals.
A substantial number of preventable deaths were identified even where risk-adjusted mortality rates were low, highlighting the limitations of report cards in detecting significant quality-of-care problems.
Veena Guru (Institute for Clinical Evaluative Sciences, Toronto, Canada) and colleagues conducted a retrospective analysis of 347 randomly selected inhospital deaths after isolated CABG surgery at nine institutions in Ontario, Canada, between 1998 and 2003.
Two experienced cardiac surgeons blinded to patients, surgeon, and hospital reviewed hospital charts, summarized by trained nurses, to identify preventable death. A third reviewer reassessed any cases on which the first two disagreed.
In all, the surgeons judged 11 (32%) of the deaths to have been preventable, despite low risk-adjusted inhospital mortality rates ranging from 1.3% to 3.1% across hospitals.
Notwithstanding this narrow range for risk-adjusted mortality, the authors note, there was no correlation between risk-adjusted mortality rates and the proportion of preventable deaths across the nine hospitals. The highest proportion of deaths deemed preventable occurred at a center in the mid-range for risk-adjusted mortality.
Based on institutional volumes, the researchers calculated that as many as 107 potentially preventable CABG-related deaths occurred in Ontario in the fiscal year 2000-2001.
The researchers identified more than one preventable cause for a given preventable death. The majority of preventable deaths were attributed to problems in the operating room (86%) or postoperative intensive care unit (61%), with a minority due to problems on the ward (15%).
A large minority of preventable deaths were associated with deviations in perioperative care (32%).
Harlan Krumholz (Yale University, New Haven, Connecticut, USA) noted in a related editorial that measuring and highlighting problems in the healthcare system requires "increasingly sophisticated approaches to diagnosing the underlying causes of suboptimal performance."
He wrote that the necessary insight "may only be achieved through implicit review of patient records and thoughtful investigation of the details of patient care," and that the current study provides an example of how this approach can best be achieved.
Circulation 2008; 117: 2969-2976
http://www.incirculation.net/NewsItem/A-third-of-CABG-deaths-could-have-been-prevented.aspx
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