Bypass aortocoronarico: mortalità a 30 giorni dall’intervento chirurgico


Indice

Descrizione indicatore

L'indicatore ci consente di calcolare il numero di pazienti sottoposti a bypass aortocoronarico che muore nei 30 giorni successivi all'intervento, rispetto al totale dei pazienti ricoverati per tale intervento.

Come si legge

L’indicatore si riferisce al grado di "efficacia" delle cure prestate. 
Più è basso il numero di pazienti sottoposti ad un intervento di bypass aortocoronarico che muore nei 30 giorni successivi, più alte sono l’efficacia e la qualità delle cure offerte dall’ospedale.

Descrizione generale

L’intervento di Bypass Aorto-Coronarico (BPAC) ha lo scopo di far superare al sangue le ostruzioni o i restringimenti (stenosi) dei vasi sanguigni (come le arterie coronarie) che portano il sangue al cuore. 
Per saperne di più sull'intervento leggi la scheda: "Cuore - Bypass aortocoronarico: volume annuale di interventi chirurgici".

Valutazione istituzionale

Il Ministero della Salute ha identificato la seguente soglia di mortalità a 30 giorni dall’intervento: 1,5%.

Codici ICD-9-CM selezionati

L’esito avverso è la morte entro 30 giorni dalla data dell’esecuzione dell’intervento di BPAC.
L’accertamento dello stato in vita viene effettuato, sulla base del SIO, sia nel ricovero per BPAC sia in eventuali ricoveri successivi del paziente entro 30 giorni e sulla base dell'Anagrafe Tributaria.
L’analisi è effettuata su base biennale.
L’evento viene attribuito alla struttura in cui è stato eseguito l’intervento di BPAC.

Criteri di eleggibilità
Tutti i ricoveri per acuti, in regime ordinario, con intervento di BPAC (codici ICD9-CM 36.10-36.19) in qualsiasi campo di procedura.

Criteri di esclusione
  • ricoveri di pazienti non residenti in Italia;
  • ricoveri di pazienti di età inferiore a 15 e superiore a 100 anni;
  • ricoveri che presentino, in qualsiasi campo di procedura, gli interventi definiti dai seguenti codici ICD-9-CM: 33.5, 33.6, 35, 36.9, 37.10, 37.11, 37.31, 37.32, 37.33, 37.4, 37.5, 38.04, 38.05, 38.14, 38.15, 38.34, 38.35, 38.45, 38.65, 38.85, 39.21, 39.22, 39.23, 39.54.

Consulta le strutture sanitarie con il minor numero di pazienti morti nei 30 giorni successivi all'intervento chirurgico di bypass aorto-coronarico


Approfondisci l'indicatore relativo al volume di interventi chirurgici di bypass aorto-coronarico


Per saperne di più sul Cuore consulta il nostro articolo "Cardiologia - Visita cardiologica: quando farla?"

Fonte del dato

Programma Nazionale Esiti 2018, indicatore 14. 
Confronto tra strutture calcolato su dati 2016-2017.

Fonte della Valutazione Istituzionale

Il semaforo è calcolato sulla base dei seguenti documenti ufficiali:

Altre fonti scientifiche

  • Sepehripour AH, Athanasiou T. Is there a surgeon or hospital volume-outcome relationship in off-pump coronary artery bypass surgery? Interact Cardiovasc Thorac Surg 2013;16(2):202-7. doi: 10.1093/icvts/ivs448.
  • Post PN, Kuijpers M, Ebels T, Zijlstra F. The relation between volume and outcome of coronary interventions: a systematic review and meta-analysis. Eur Heart J 2010;31(16):1985-92.
  • Kalant N, Shrier I. Volume and outcome of coronary artery bypass graft surgery: are more and less the same? Can J Cardiol 2004;20(1):81-6.
  • Gandjour A, Bannerberg A, Lauterbach KW. Threshold volumes associated with higher survival in health care. Med Care 2003;41(10):1129-41.
  • Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med 2002:137(6):511-20.
  • Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 2000; 283(9):1159-66.
  • Agostini M, Fino C, Torchio P et al. High OPCAB surgical volume improves mid-term event-free survival. Heart Surg Forum 2009;12(5):E250-55.
  • Allareddy V, Allareddy V, Konety BR. Specificity of procedure volume and in-hospital mortality association. Ann Surg 2007;246(1):135-39.
  • Birkmeyer JD, Siewers AE, Finlayson EV et al. Hospital volume and surgical mortality in the United States. N Engl JMed 2002;346(15):1128-37.
  • Brown PP, Mack MJ, Simon AW et al. Comparing clinical outcomes in high-volume and low-volume off-pump coronary bypass operation programs. Ann Thorac Surg 2001;72(3):S1009-15.
  • Burns LR, Wholey DR. The effects of patient, hospital, and physician characteristics on length of stay and mortality. Med Care 1991;29(3):251-71.
  • Carey JS, Danielsen B, Gold JP, Rossiter SJ. Procedure rates and outcomes of coronary revascularization procedures in California and New York. J Thorac Cardiovasc Surg 2005;129(6):1276-82.
  • Christian CK, Gustafson ML, Betensky RA, Daley J, Zinner MJ. The leapfrog volume criteria may fall short in identifying high-quality surgical centers. Annals of Surg 2003;238(4):447-55; discussion 455-57.
  • Clark RE. Outcome as a function of annual coronary artery bypass graft volume. The Ad Hoc Committee on Cardiac Surgery Credentualing on the Society of Thoracic Surgeons. Ann Thorac Surg 1996;61(1):21-6.
  • Farley DE, Ozminkowski RJ. Volume-outcome relationships and inhospital mortality: the effect of changes in volume over time. Med Care 1992;30(1):77-94. 
  • Ghali WA, Quan H, Brant R. Coronary artery bypass grafting in Canada: hospital mortality rates, 1992-1995. CMAJ 1998;159(8):926-30.
  • Glance LG, Dick AW, Osler TM, Mukamel DB. The relation between surgeon volume and outcome following off-pump vs. on-pump coronary artery bypass graft surgery. Chest 2005;128(2):829-37.
  • Grumbach K, Anderson GM, Luft HS, Roos LL, Brook R. Regionalization of cardiac surgery in the United States and Canada. Geographic access, choice, and outcomes. JAMA 1995;274(16):1282-88.
  • Hannan EL, Kilburn H Jr, Racz M, Shields E, Chassin MR. Improving the outcomes of coronary artery bypass surgery in New York State. JAMA 1994;271(10): 761-66.
  • Hannan EL, Kilburn H Jr, Bernard H, O’Donnell JF, Lukacik G, Shields EP. Coronary artery bypass surgery: the relationship between inhospital mortality rate and surgical volume after controlling for clinical risk factors. Med Care 1991;29(11):1094-107.
  • Hannan EL, O’Donnell JF, Kilburn H Jr, Bernard HR, Yazici A. Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals. JAMA 1989;262(4):503-10.
  • Hannan EL, Siu AL, Kumar D, Kilburn H Jr, Chassin MR. The decline in coronary artery bypass graft surgery mortality in New York State. The role of surgeon volume. JAMA 1995;273(3):209-13.
  • Hughes RG, Hunt SS, Luft HS. Effects of surgeon volume and hospital volume on quality of care in hospitals. Med Care 1987;25(6):489-503.
  • Johnson AN. The relationship between volume, quality and outcome in hospital care delivery. Minnesota, University of Minnesota, 1988.
  • Kelly JV, Hellinger FJ. Heart disease and hospital deaths: an empirical study. Health Serv Res 1987;22(3):369-95.
  • Konety SH, Rosenthal GE, Vaughan-Sarrazin MS. Surgical volume and outcomes of off-pump coronary artery bypass graft surgery: does it matter? J Thorac Cardio- vasc Surg 2009;137(5):1116-23.
  • Lapar DJ, Mery CM, Kozower BD et al. The effect of surgeon volume on mortality for off-pump coronary artery bypass grafting. J Thorac Cardiovasc Surg 2012; 143(4):854-63.
  • Leape LL, Hilborne LH, Park RE et al. The appropriateness of use of coronary artery bypass graft surgery in New York State. JAMA 1993;269(6):753-60.
  • Luft HS, Bunker JP, Enthoven AC. Should opeartions be regionalised? The empirical relation between surgical volume and mortality. N Eng J Med 1979; 301(25):1364-9.
  • Luft HS, Hunt SS, Maerki SC. The volume-outcome relationship: practice-makes- perfect or selective-referral patterns? Health Ser Res 1987;22(2):157-82. 
  • Maerki SC, Luft HS, Hunt SS. Selecting categories of patients for regionalization. Implications of the relationship between volume and outcome. Med Care 1986;24(2):148-58.
  • Marcin JP, Li Z, Kravitz RL, Dai JJ, Rocke DM, Romano PS. The CABG surgery volume-outcome relationship: temporal trends and selection effects in California, 1998-2004. Health Serv Res 2008;43(1 Pt 1):174-92.
  • Nallamothu BK, Saint S, Ramsey SD, Hofer TP, Vijan S, Eagle KA. The role of hospital volume in coronary artery bypass grafting: is more always better? J Am Coll Cardiol 2001;38(7):1923-30.
  • Plomondon ME, Casebeer AW, Schooley LM et al. Exploring the volume-outcome relationship for off-pump coronary artery bypass graft procedures. Ann Thorac Surg 2006;81(2):547-53.
  • Riley G, Lubitz J. Outcomes of surgery among the Medicare aged: surgical volume and mortality. Health Care Financ Rev 1985;7(1):37-47.
  • Rosenfeld K, Luft HS, Garnick DW, McPhee SJ. Changes in patient characteristics and surgical outcomes for coronary artery bypass surgery 1972-82. Am J Public Health 1987;77(4):498-500.
  • Showstack JA, Rosenfeld KE, Garnick DW, Luft HS, Schaffarzick RW, Fowles J. Association of volume with outcome of coronary artery bypass graft surgery. Scheduled vs nonscheduled operations. JAMA 1987;257(6):785-89.  
  • Shroyer AL, Marshall G, Warner BA et al. No continuous relationship between Veterans Affairs hospital coronary artery bypass grafting surgical volume and operative mortality. Ann Thorac Surg 1996;61(1):17-20.  
  • Sollano JA, Gelijns AC, Moskowitz AJ et al. Volume-outcome relationships in cardiovascular operations: New York State, 1990-1995. J Thorac Cardiovasc Surg 1999;117:419-28; discussion 428-30.  
  • Wu SC, Chien LN, Ng YY, Chu HF, Chen CC. Association of case volume with mortality of Chinese patients after coronary artery bypass grafting: Taiwan experience. Circ J 2005;69(11):1327-32.  
  • Zelen J, Bilfinger TV, Anagnostopoulos CE. Coronary artery bypass grafting. The relationship of surgical volume, hospital location, and outcome. NY State J Med 1991;91:290-92.
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