文章摘要

腹主动脉腔内修复手术质量评价指标体系的中国专家共识

作者: 1国家心血管病专业质控中心专家委员会 血管外科专家工作组
1 国家心血管病专业质控中心专家委员会血管外科专家工作组
通讯: 国家心血管病专业质控中心专家委员会 血管外科专家工作组 Email: Changshu01@yahoo.com
DOI: 10.3978/.2018.06.001

摘要

近年来,中国腹主动脉腔内修复手术(EVAR)的实施规模快速扩增,实施单位由早年的区域中心医院扩展到部分省市的中型医院,与医疗水平均一性差、医疗资源消耗不合理相关的质量问题逐渐显现。如何评价和改善医疗质量、提高国家医疗卫生支出的利用效率这一重大课题,引起了国家卫生主管部门高度重视。经国家心血管病专业质控中心专家委员会血管外科专家工作组全体专家讨论,拟定了术前CTA检查、术中血压监测和控制性血压调节、术中覆膜支架放大使用率、术后CTA复查率等4项过程指标,风险校正术后30 d病死率、风险校正术后30 d全因再入院率、中转开放手术发生率、入路血管再次干预发生率、主髂动脉再次干预率、手术时间、ICU停留时间、机械通气时间延长发生率、术后肾功能不全发生率、患者术后住院天数等10项结局指标,以及注册登记参与率这一项结构指标,以期通过上述关键指标的考核、推广,提高不同地域、不同级别医院EVAR手术质量的均一性。
关键词: 主动脉,腹;血管内操作;卫生保健评价机制;总结性报告(主题)

Chinese experts' consensus on the evaluation index system of endovascular abdominal aortic aneurysm repair

Authors:

Email: Changshu01@yahoo.com

Abstract

In recent years, the scale of the endovascular abdominal aortic aneurysm repair (EVAR) in China has rapidly expanded, while the operation units have expanded from the regional center hospitals in the early years to the medium-sized hospitals in many provinces and cities. The quality problems related to the poor homogeneity of medical level and the unreasonable consumption of medical resources have gradually emerged. The major issue of how to evaluate and improve the quality of medical care and improve the utilization efficiency of national healthcare expenditures has drawn great attention from the national health authorities. All members of Working Group on Vascular Surgery, National Center for Cardiovascular Quality Improvement have discussed and formulated process index, outcome index and structural index for EVAR. Process index includes preoperative CTA examination, blood pressure monitoring and control during the operation, suitable oversizing of stent graft, and postoperative CTA review. Outcome index includes risk-adjusted 30-day mortality, risk-adjusted 30-day all-cause re-admission rate, incidence of conversions to open surgery, incidence of re-intervention for the access vessel, re-intervention rate for the abdominal aorta and iliac arteries, operation time, ICU stay time, incidence of prolonged mechanical ventilation, postoperative renal insufficiency, and postoperative hospitalization days. Structural index includes participation rate of registration researches. With the promoting and assessing of above-mentioned key indexes, the homogeneity of EVAR surgical quality in different hospitals from different regions and levels will hopefully be improved.uation; Expert Consensus.
Keywords: Aorta Abdominal; Endovascular Procedures; Health Care Evaluation Mechanisms; Consensus Development Conferences as Topic