Abstract：
Background: The Veterans affairs (VA) surgical quality improvement program was established to evaluate the quality of VA surgical care to over nine million United States Veterans. Patient demographics vary by region, with urban areas correlating with higher mortality rates. This study attempts to determine the factors associated with 30-day mortality at a single VA medical center in an urban setting. Methods: Patients included in the study were at least 18 years of age and underwent a surgical procedure between January 2013 and June 2023. Baseline demographics included preoperative comorbidities, American Society of Anesthesiology (ASA) class, and preoperative lab values. Clinical outcomes included postoperative mortality within 30 days of the procedure. Chi-square, t-test, ANOVA, and multivariate logistic regressions were used to determine relationships, using P < .05 to determine significance. Results: A total of 11,547 patients with complete data were included, of which 92 patients (0.8%) died within 30 days of surgery. A higher preoperative hematocrit was protective against 30-day mortality. A perioperative transfusion, bleeding disorder, chronic obstructive pulmonary disease (COPD), history of a myocardial infarction, higher ASA class, and an emergency procedure all increased the likelihood of perioperative mortality. Conclusions: Veterans who seek surgical care at Veterans Health Administration centers receive high quality care with a low mortality rate. Identifying risk factors for perioperative mortality provides the opportunity to stratify those veterans at highest risk.
摘要：
背景：建立了退伍军人事务（VA）手术质量改进计划，以评估超过900万美国退伍军人的VA手术护理质量。患者的人口统计学因地区而异，城市地区与较高的死亡率相关。这项研究试图确定与城市环境中单个VA医疗中心30天死亡率相关的因素。方法：纳入研究的患者年龄至少为18岁，在2013年1月至2023年6月期间接受了外科手术。基线人口统计学包括术前合并症，美国麻醉学会（ASA）班，和术前实验室值。临床结果包括手术后30天内的术后死亡率。卡方，t检验,方差分析,多元逻辑回归用于确定关系，使用P<.05来确定显著性。结果:共纳入11547例数据完整的患者,其中92例(0.8%)在手术后30天内死亡。较高的术前血细胞比容可以预防30天的死亡率。围手术期输血，出血性疾病,慢性阻塞性肺疾病(COPD),心肌梗塞的病史,更高的ASA级，和急诊手术都增加了围手术期死亡率的可能性。结论：在退伍军人健康管理中心寻求手术护理的退伍军人可以获得高质量的护理，死亡率低。确定围手术期死亡的危险因素提供了分层那些风险最高的退伍军人的机会。
