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Abstract：
BACKGROUND: This study analyses the association between hospital ownership and patient selection, treatment, and outcome of carotid endarterectomy (CEA) or carotid artery stenting (CAS).
METHODS: The analysis is based on the Bavarian subset of the nationwide German statutory quality assurance database. All patients receiving CEA or CAS for carotid artery stenosis between 2014 and 2018 were included. Hospitals were subdivided into four groups: university hospitals, public hospitals, hospitals owned by charitable organizations, and private hospitals. The primary outcome was any stroke or death until discharge from hospital. Research was funded by Germany\'s Federal Joint Committee Innovation Fund (01VSF19016 ISAR-IQ).
RESULTS: In total, 22,446 patients were included. The majority of patients were treated in public hospitals (62%), followed by private hospitals (17%), university hospitals (16%), and hospitals under charitable ownership (6%). Two thirds of patients were male (68%), and the median age was 72 years. CAS was most often applied in university hospitals (25%) and most rarely used in private hospitals (9%). Compared to university hospitals, patients in private hospitals were more likely asymptomatic (65% vs. 49%). In asymptomatic patients, the risk of stroke or death was 1.3% in university hospitals, 1.5% in public hospitals, 1.0% in hospitals of charitable owners, and 1.2% in private hospitals. In symptomatic patients, these figures were 3.0%, 2.5%, 3.4%, and 1.2% respectively. Univariate analysis revealed no statistically significant differences between hospital groups. In the multivariable analysis, compared to university hospitals, the odds ratio of stroke or death in asymptomatic patients treated by CEA was significantly lower in charitable hospitals (OR 0.19 [95%-CI 0.07-0.56, p = 0.002]) and private hospitals (OR 0.47 [95%-CI 0.23-0.98, p = 0.043]). In symptomatic patients (elective treatment, CEA), patients treated in private or public hospitals showed a significantly lower odds ratio compared to university hospitals (0.36 [95%-CI 0.17-0.72, p = 0.004] and 0.65 [95%-CI 0.42-1.00, p = 0.048], respectively).
CONCLUSIONS: Hospital ownership was related to patient selection and treatment, but not generally to outcomes. The lower risk of stroke or death in the subgroup of electively treated patients in private hospitals might be due to the right timing, the choice of treatment modality or actually to better structural and process quality.
METHODS: The analysis is based on the Bavarian subset of the nationwide German statutory quality assurance database. All patients receiving CEA or CAS for carotid artery stenosis between 2014 and 2018 were included. Hospitals were subdivided into four groups: university hospitals, public hospitals, hospitals owned by charitable organizations, and private hospitals. The primary outcome was any stroke or death until discharge from hospital. Research was funded by Germany\'s Federal Joint Committee Innovation Fund (01VSF19016 ISAR-IQ).
RESULTS: In total, 22,446 patients were included. The majority of patients were treated in public hospitals (62%), followed by private hospitals (17%), university hospitals (16%), and hospitals under charitable ownership (6%). Two thirds of patients were male (68%), and the median age was 72 years. CAS was most often applied in university hospitals (25%) and most rarely used in private hospitals (9%). Compared to university hospitals, patients in private hospitals were more likely asymptomatic (65% vs. 49%). In asymptomatic patients, the risk of stroke or death was 1.3% in university hospitals, 1.5% in public hospitals, 1.0% in hospitals of charitable owners, and 1.2% in private hospitals. In symptomatic patients, these figures were 3.0%, 2.5%, 3.4%, and 1.2% respectively. Univariate analysis revealed no statistically significant differences between hospital groups. In the multivariable analysis, compared to university hospitals, the odds ratio of stroke or death in asymptomatic patients treated by CEA was significantly lower in charitable hospitals (OR 0.19 [95%-CI 0.07-0.56, p = 0.002]) and private hospitals (OR 0.47 [95%-CI 0.23-0.98, p = 0.043]). In symptomatic patients (elective treatment, CEA), patients treated in private or public hospitals showed a significantly lower odds ratio compared to university hospitals (0.36 [95%-CI 0.17-0.72, p = 0.004] and 0.65 [95%-CI 0.42-1.00, p = 0.048], respectively).
CONCLUSIONS: Hospital ownership was related to patient selection and treatment, but not generally to outcomes. The lower risk of stroke or death in the subgroup of electively treated patients in private hospitals might be due to the right timing, the choice of treatment modality or actually to better structural and process quality.
摘要：
背景：本研究分析了医院所有权与患者选择之间的关联，治疗,颈动脉内膜切除术（CEA）或颈动脉支架置入术（CAS）的结果。
方法：分析基于德国全国法定质量保证数据库的巴伐利亚子集。纳入2014年至2018年间接受CEA或CAS治疗颈动脉狭窄的所有患者。医院被细分为四组：大学医院，公立医院,慈善机构拥有的医院，私人医院。主要结果是任何中风或死亡，直到出院。研究由德国联邦联合委员会创新基金（01VSF19016ISAR-IQ）资助。
结果：总计，包括22,446名患者。大部分病人在公立医院接受治疗(62%),其次是私立医院(17%)，大学医院（16%），和慈善所有权下的医院(6%)。三分之二的患者为男性（68%），中位年龄为72岁。CAS在大学医院中最常用（25％），在私立医院中很少使用（9％）。与大学医院相比，私立医院的患者更有可能无症状(65%vs.49%)。在无症状患者中，在大学医院，中风或死亡的风险为1.3%，公立医院的1.5%，1.0%在慈善业主的医院，私立医院占1.2%。在有症状的患者中，这些数字是3.0%，2.5%,3.4%,分别为1.2%。单因素分析显示，医院组间差异无统计学意义。在多变量分析中，与大学医院相比，在慈善医院(OR0.19[95%-CI0.07~0.56,p=0.002])和私立医院(OR0.47[95%-CI0.23~0.98,p=0.043])中,接受CEA治疗的无症状患者的卒中或死亡比值比显著降低.在有症状的患者中（选择性治疗，CEA)，与大学医院相比，在私立或公立医院接受治疗的患者的比值比明显较低(0.36[95%-CI0.17-0.72，p=0.004]和0.65[95%-CI0.42-1.00，p=0.048]，分别)。
结论：医院所有权与患者选择和治疗有关，但不是一般的结果。在私立医院接受择期治疗的患者亚组中，中风或死亡的风险较低可能是由于正确的时机，治疗方式的选择，或者实际上是为了更好的结构和过程质量。
方法：分析基于德国全国法定质量保证数据库的巴伐利亚子集。纳入2014年至2018年间接受CEA或CAS治疗颈动脉狭窄的所有患者。医院被细分为四组：大学医院，公立医院,慈善机构拥有的医院，私人医院。主要结果是任何中风或死亡，直到出院。研究由德国联邦联合委员会创新基金（01VSF19016ISAR-IQ）资助。
结果：总计，包括22,446名患者。大部分病人在公立医院接受治疗(62%),其次是私立医院(17%)，大学医院（16%），和慈善所有权下的医院(6%)。三分之二的患者为男性（68%），中位年龄为72岁。CAS在大学医院中最常用（25％），在私立医院中很少使用（9％）。与大学医院相比，私立医院的患者更有可能无症状(65%vs.49%)。在无症状患者中，在大学医院，中风或死亡的风险为1.3%，公立医院的1.5%，1.0%在慈善业主的医院，私立医院占1.2%。在有症状的患者中，这些数字是3.0%，2.5%,3.4%,分别为1.2%。单因素分析显示，医院组间差异无统计学意义。在多变量分析中，与大学医院相比，在慈善医院(OR0.19[95%-CI0.07~0.56,p=0.002])和私立医院(OR0.47[95%-CI0.23~0.98,p=0.043])中,接受CEA治疗的无症状患者的卒中或死亡比值比显著降低.在有症状的患者中（选择性治疗，CEA)，与大学医院相比，在私立或公立医院接受治疗的患者的比值比明显较低(0.36[95%-CI0.17-0.72，p=0.004]和0.65[95%-CI0.42-1.00，p=0.048]，分别)。
结论：医院所有权与患者选择和治疗有关，但不是一般的结果。在私立医院接受择期治疗的患者亚组中，中风或死亡的风险较低可能是由于正确的时机，治疗方式的选择，或者实际上是为了更好的结构和过程质量。
