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[BMJ最新论文]:外科医生性别年龄与老年外科患者病死率
2018年05月14日 时讯速递, 进展交流 暂无评论

Research

Age and sex of surgeons and mortality of older surgical patients: observational study

Yusuke Tsugawa, Anupam B Jena, E John Orav, et al.

BMJ 2018; 361: k1343

doi: https://doi.org/10.1136/bmj.k1343 (Published 25 April 2018)

Abstract

Objective 目的

To investigate whether patients’ mortality differs according to the age and sex of surgeons.

研究患者病死率是否受到外科医生年龄与性别的影响。

Design 设计

Observational study.

观察性研究

Setting 场景

US acute care hospitals.

美国急性病医院

Participants 研究对象

100% of Medicare fee-for-service beneficiaries aged 65-99 years who underwent one of 20 major non-elective surgeries between 2011 and 2014.

2011至2014年间,接受20种非择期大手术的65-99岁之间Medicare免费医疗所有患者

Main outcome measure 主要预后指标

Operative mortality rate of patients, defined as death during hospital admission or within 30 days of the operative procedure, after adjustment for patients’ and surgeons’ characteristics and indicator variables for hospitals.

手术病死率定义为住院过程中或手术后30天内死亡。根据患者和外科医生特征以及医院指标对手术病死率进行校正。

Results 结果

892 187 patients who were treated by 45 826 surgeons were included. Patients’ mortality was lower for older surgeons than for younger surgeons: the adjusted operative mortality rates were 6.6% (95% confidence interval 6.5% to 6.7%), 6.5% (6.4% to 6.6%), 6.4% (6.3% to 6.5%), and 6.3% (6.2% to 6.5%) for surgeons aged under 40 years, 40-49 years, 50-59 years, and 60 years or over, respectively (P for trend=0.001). There was no evidence that adjusted operative mortality differed between patients treated by female versus male surgeons (adjusted mortality 6.3% for female surgeons versus 6.5% for male surgeons; adjusted odds ratio 0.97, 95% confidence interval 0.93 to 1.01). After stratification by sex of surgeon, patients’ mortality declined with age of surgeon for both male and female surgeons (except for female surgeons aged 60 or older); female surgeons in their 50s had the lowest operative mortality.

研究纳入45826名外科医生治疗的892187名患者。与年轻医生相比,年长外科医生经治患者的病死率较低:对于40岁以下,40-49岁,50-59岁及60岁以上外科医生,校正后手术病死率分别为 6.6%(95%可信限 6.5% to 6.7%),6.5% (6.4% to 6.6%),6.4% (6.3% to 6.5%)及6.3% (6.2% to 6.5%)(趋势P=0.001)。没有证据表明女性与男性外科医生经治患者的校正手术病死率存在任何差异(女性外科医生校正病死率6.3%;男性外科医生6.5%;校正比数比0.97,95%可信限0.93-1.01)。根据外科医生性别进行分层后发现,无论男性或女性外科医生,随着年龄增加,患者病死率降低(除60岁以上女性外科医生外);50-59岁女性外科医生手术病死率最低。

Conclusion 结论

Using national data on Medicare beneficiaries in the US, this study found that patients treated by older surgeons had lower mortality than patients treated by younger surgeons. There was no evidence that operative mortality differed between male and female surgeons.

根据美国Medicare全国数据分析,本研究发现,与年轻外科医生相比,年长外科医生经治患者的病死率较低。没有证据表明男性与女性外科医生的手术病死率存在差异。

 

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