摘要
目的:分析自1991年来,在布里斯托尔及全英国, 小儿心脏直视手术死亡率的变化趋势。设计:回顾性分析医院病例统计数据。机构:所有开展小儿心脏直视手术的英国医院。试验对象:收集1991年4月至2002年3 月间,接受心脏直视手术、年龄小于16岁的患者。对3 个时间段的死亡率进行研究:阶段3(1991年4月至1995年3月),阶段5(1996年4月至1999年3月)。
Objective: To describe trends in mortality of open cardiac surgery in children in Bristol and England since 1991. Design: Retrospective analysis of hospital episode statistics data. Setting: All open cardiac surgery of children in England. Population: Patients younger than 16 undergoing open cardiac surgical procedures in England between April 1991 and March 2002. Three time periods were defined: epoch 3 (April 1991 to March 1995), epoch 5 (April 1996 to March 1999), epoch 6 (April 1999 to March 2002) -. Main outcome measure: Mortality in hospital within 30 days of a cardiac procedure. Results: We identified 5221 open operations between April 1996 and March 2002 in children under 1 year and 6385 in children aged 1-15 years. Mortality for all centres combined fell from 12% in epoch 3 to 4% in epoch 6. Mortality in children under 1 year at Bristol fell from 29% (95% confidence interval 21% to 37% ) in epoch 3 to 3% (1% to 6% ) in epoch 6, below the national average. The reduction in mortality did not seem to be due to fewer high risk procedures or an increase in the numbers of low risk cases. Oxford had a significantly higher mortality than the national average in all three epochs (11% (5% to 18% ) in epoch 6), which was not affected by adjusting for procedure or the inclusion of cases with missing outcomes. Conclusions: At Bristol, mortality for open operations in children aged under 1 year has fallen markedly, to below the national average. Nationwide mortality has also fallen. Improved quality of care may account for the drop in mortality, through new tech- nologies or improved perioperative and postoperative care, or both.
