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RISS 인기검색어
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- 저자 : PRONOVOST, PETER JOHN (검색결과 1 건)
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PRONOVOST, PETER JOHN THE JOHNS HOPKINS UNIVERSITY 1999 해외박사(DDOD)
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<italic>Background</italic>. Morbidity and mortality rates in intensive care units (ICUs) vary widely between institutions. We sought (1) to evaluate how organizational characteristics of ICUs are related to clinical and economic outcomes for abdominal aortic surgery patients that typically receive care in an ICU, (2) to assess the current variation in complication rates, and (3) to evaluate the association between specific types of complications and in-hospital mortality and total hospital charges, for patients having abdominal aortic surgery. <italic>Methods. Patient data</italic>. We analyzed hospital discharge data on patients in non-federal acute care hospitals in Maryland who had a principal procedure code for abdominal aortic surgery from 1/94–12/96 (N = 2987). We used discharge diagnosis and procedure codes to identify diagnoses that most likely represent major complications of surgery. <italic>ICU data</italic>. We obtained information on ICU organizational characteristics by surveying ICU medical directors at the 46 Maryland hospitals that performed abdominal aortic surgery. Thirty-nine (85%) of the ICU directors completed this survey. <italic>Outcomes</italic>. The primary outcomes were in-hospital mortality, hospital length of stay, and ICU days. <italic>Risk adjustment</italic>/<italic>analysis</italic>. We adjusted for demographic characteristics, comorbid disease, and severity of illness, and hospital and surgeon volume. We used multilevel modeling in the analysis to differentiate the effects of patients and hospitals on outcomes. <italic>Results</italic>. For abdominal aortic surgery patients, in-hospital mortality varied between hospitals from 0% to 66%. In multivariate analysis, not having daily rounds by an ICU physician was associated with a 3-fold increase in in-hospital mortality (95% confidence interval [CI] 1.9–4.9) and an increased risk of several specific complications. The rates of compilations vary widely between hospitals. Complications independently associated with increased risk of in-hospital death include cardiac arrest (Odds ratio [OR] 90; 95% confidence interval [CI] 32 to 251), septicemia (OR 6.1; CI 3.3 to 11.3), acute myocardial infarction (OR 5.7; CI 2.3 to 14.3), acute renal failure (OR 5.0; CI 2.3 to 11.0), surgical complications after a procedure (OR 3.1; CI 2.0 to 4.9), reoperation for bleeding (OR 2.2; 1.1 to 4.8) and reintubation (OR 1.9; CI 1.3 to 2.8). Complications explained 25% of the variance in hospital charges between patients with the highest amount of charges attributable to septicemia (mean increase 68%; CI 48%–91%) and postoperative infection (mean increase 64%; CI 45%–85%). <italic>Conclusion</italic>. Organizational characteristics of ICUs and complications are related to differences between hospitals in outcomes of abdominal aortic surgery. Clinicians and hospital leaders should consider the potential impact of ICU organizational characteristics on outcomes of high-risk operations. Efforts to reduce these complications should help to decrease both in-hospital mortality and costs.
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