Publication: Modelos de predicción de mortalidad en cirugía cardiaca: diseño de un modelo, evaluación de modelos generales y análisis de mortalidad ajustada a riesgo
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2017-08-28
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Universidad Complutense de Madrid
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Abstract
Las intervenciones de cirugía cardiaca tienen costes elevados, emplean recursos complejos, y se asocian a riesgos quirúrgicos medios comparativamente más elevados que la mayor parte de las demás disciplinas quirúrgicas. Es un área de especial interés para los estudios de evaluación de riesgo y de análisis de calidad. El parámetro más empleado como variable de medición es la mortalidad hospitalaria, por su relevancia clínica, facilidad de medir, y estandarización. La necesidad de establecer rangos de mortalidad aceptable ha originado iniciativas nacionales para medirlo. Ningún organismo emite datos de mortalidad por tipo de procedimiento ajustado a riesgo de los servicios cardioquirúrgicos adaptados a criterios acordados con las sociedades científicas. Las fuentes existentes son las memorias de resultados de las Consejerías, los registros de gastos y el Registro de Actividad de la SECTCV. Ninguna de estas fuentes contiene información paciente a paciente, ni información pronóstica de los pacientes. La fuente más útil a nivel clínico es el Registro de Intervenciones de la SECTCV. El análisis de la mortalidad debe tener en cuenta el riesgo de los pacientes. Los modelos de predicción de mortalidad estiman este riesgo...
Cardiac surgery procedures are expensive, use sensible resources, and are associated with higher risks than the rest of normal surgery activities in the average hospital. Therefore, it is an area of interest for risk evaluation and quality control. The output usually selected to assess the performance of a surgical unit is mortality in hospital. Although not a comprehensive parameter, it is a relevant clinical event, it is easy to measure, and the criteria to be met are well identified. Many national records aim to determine suitable mortality rate have been introduce during these years. However, no government institution has published national outcomes in cardiac surgery by means of risk stratification following scientific societies recommendations. Regional governments activity reports, industrial records, and the highly recommended National Procedures Record annually issued by the Spanish Thoracic-Cardiovascular Society (SECTCV) are available, although detailed information about patient to patient outcome is not available on any of them...
Cardiac surgery procedures are expensive, use sensible resources, and are associated with higher risks than the rest of normal surgery activities in the average hospital. Therefore, it is an area of interest for risk evaluation and quality control. The output usually selected to assess the performance of a surgical unit is mortality in hospital. Although not a comprehensive parameter, it is a relevant clinical event, it is easy to measure, and the criteria to be met are well identified. Many national records aim to determine suitable mortality rate have been introduce during these years. However, no government institution has published national outcomes in cardiac surgery by means of risk stratification following scientific societies recommendations. Regional governments activity reports, industrial records, and the highly recommended National Procedures Record annually issued by the Spanish Thoracic-Cardiovascular Society (SECTCV) are available, although detailed information about patient to patient outcome is not available on any of them...
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Tesis inédita de la Universidad Complutense de Madrid, Facultad de Medicina, Departamento de Cirugía, leída el 02-02-2016