TY - JOUR
T1 - Risk stratification for open heart operations
T2 - Comparison of centers regardless of the influence of the surgical team
AU - Pinna-Pintor, Plinio
AU - Bobbio, Marco
AU - Sandrelli, Luca
AU - Giammaria, Massimo
AU - Patané, Francesco
AU - Bartolozzi, Silvia
AU - Bergandi, Gianluigi
AU - Alfieri, Ottavio
PY - 1997/8
Y1 - 1997/8
N2 - Background. Risk-adjusted mortality was previously used to compare institutions as a whole or surgeons. Because the same surgical team is working in two different hospitals, the aim of our study was to assess whether the institution can make a difference in surgical mortality. Methods. Preoperative data of 554 patients in institution A and 500 in institution B were prospectively collected during the same period of time. All patients were operated on by the same surgeon with the same first assistant and anesthesiology staff in both institutions. Patient population was stratified according to Parsonnet's predictive model, in five risk groups, and mortality was adjusted by the direct standardization method. Results. At institution A it was observed that in-hospital mortality was 2.3% (95% confidence interval, 1.3% to 4.0%), and in institution B 4.0% (95% confidence interval, 2.5% to 6.1%). The difference between the two mortality rates (1.7%; 95% confidence interval, -0.5% to 3.8%) is not statistically significant (p = 0.16), nor is the difference within each class. The standardized mortality ratio was 3.6% (95% confidence interval, 2.7% to 4.8%) and 5.8% (95% confidence interval, 4.6% to 7.2%), respectively. The difference of 2.2% (95% confidence interval, 0.5% to 3.8%) is statistically significant (p = 0.01). Conclusions. The institution can affect mortality of patients undergoing open heart operations, regardless of the influence of the surgical team.
AB - Background. Risk-adjusted mortality was previously used to compare institutions as a whole or surgeons. Because the same surgical team is working in two different hospitals, the aim of our study was to assess whether the institution can make a difference in surgical mortality. Methods. Preoperative data of 554 patients in institution A and 500 in institution B were prospectively collected during the same period of time. All patients were operated on by the same surgeon with the same first assistant and anesthesiology staff in both institutions. Patient population was stratified according to Parsonnet's predictive model, in five risk groups, and mortality was adjusted by the direct standardization method. Results. At institution A it was observed that in-hospital mortality was 2.3% (95% confidence interval, 1.3% to 4.0%), and in institution B 4.0% (95% confidence interval, 2.5% to 6.1%). The difference between the two mortality rates (1.7%; 95% confidence interval, -0.5% to 3.8%) is not statistically significant (p = 0.16), nor is the difference within each class. The standardized mortality ratio was 3.6% (95% confidence interval, 2.7% to 4.8%) and 5.8% (95% confidence interval, 4.6% to 7.2%), respectively. The difference of 2.2% (95% confidence interval, 0.5% to 3.8%) is statistically significant (p = 0.01). Conclusions. The institution can affect mortality of patients undergoing open heart operations, regardless of the influence of the surgical team.
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U2 - 10.1016/S0003-4975(97)00534-1
DO - 10.1016/S0003-4975(97)00534-1
M3 - Article
C2 - 9262585
AN - SCOPUS:0030801210
VL - 64
SP - 410
EP - 413
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 2
ER -