Análisis de la mortalidad intrahospitalaria de la cirugía de revascularización coronaria

Abstract

Outcomes research and monitoring are of key importance in efforts to improve health care effectiveness and quality. The aim of this study was to describe in-hospital mortality from coronary artery bypass grafting in Spain. Data in an administrative database were used to estimate the statistical performance of two risk-adjustment methods, the Charlson and Ghali indexes. From the Spanish Hospital Minimum Basic Data Set corresponding to 1997 and 1998 all records which included a code for coronary artery bypass grafting were selected. With in-hospital mortality as the outcome variable, two risk-adjusted logistic multiple regression models were constructed. The database included 13,203 cases, of which 80% were men; mean age was 64.5 years. In-hospital mortality was 7.3%. The figure was significantly higher for women and increased with age. A score of one on the Charlson and Ghali indexes was associated, respectively, with a 23 and 20% increase in the risk of mortality. Probability calculated with the Hosmer-Lemeshow goodness of fit test was 0.765 and 0.965, and the C index was 0.66 and 0.67. Values of Nagelkerke's R2 were 0.051 y 0.058. In-hospital mortality from coronary artery bypass grafting is much higher in Spain than in other countries. The Minimum Basic Data Set, a low-cost information system that is easy to access, yields interesting and useful information to measure health care quality.