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Should all pancreatic surgery be centralized regardless of patients' comorbidity?
HPB ( IF 2.9 ) Pub Date : 2019-11-26 , DOI: 10.1016/j.hpb.2019.10.2443
Mehdi El Amrani 1 , Guillaume Clément 2 , Xavier Lenne 2 , Claire Laueriere 2 , Anthony Turpin 3 , Didier Theis 2 , François-René Pruvot 1 , Stéphanie Truant 1
Affiliation  

Background

It remains to be established whether centralization to high volume centers is essential for all patients undergoing pancreatic surgery. The aims of this study were to identify the optimal cut-off volume to optimize patient outcomes and to determine if patient comorbidity affected the volume-outcome relationship.

Methods

Patients undergoing pancreatectomy from 2012 to 2015 were retrospectively identified (n = 12 333) in the French nationwide database. The 90-day Post-Operative Mortality (POM) was analyzed according to hospital volume of pancreatectomy (very low:<10, Low:10–19, High:20–49 and very high:≥50 resections/year) and Charlson Comorbidity Index (ChCI).

Results

The overall POM was 6.9%. The cut-off of 20 pancreatic resections per year was identified as predictor of POM. Compared to high volume centers, POM was significantly higher in low and very low volume centers whatever the ChCl. Regarding surgical procedures, there was a significant decrease in POM with increasing hospital volume only after pancreaticoduodenectomy regardless of the ChCl. On multivariable analysis, low and very low volume centers were independently associated with increased mortality rates.

Conclusion

The optimal cut-off of annual caseload was 20 pancreatic resections. POM following pancreaticoduodenectomy is high in low and very low volume centers independently of ChCl, suggesting that this procedure should be centralized.



中文翻译:

无论患者有无合并症,所有的胰腺手术都应该集中吗?

背景

对于所有接受胰腺手术的患者来说,集中到高容量中心是否必不可少还有待确定。本研究的目的是确定最佳截止体积以优化患者结果并确定患者合并症是否影响体积-结果关系。

方法

在法国全国数据库中回顾性确定了 2012 年至 2015 年接受胰腺切除术的患者(n = 12 333)。根据胰腺切除术的医院容量(非常低:<10,低:10-19,高:20-49 和非常高:≥50 次切除/年)和 Charlson 合并症分析 90 天术后死亡率 (POM)指数 (ChCI)。

结果

总体 POM 为 6.9%。每年 20 次胰腺切除的临界值被确定为 POM 的预测指标。与高体积中心相比,无论是何种 ChCl,低体积和极低体积中心的 POM 都显着更高。关于外科手术,仅在胰十二指肠切除术后,POM 随医院容量的增加而显着降低,而与 ChCl 无关。在多变量分析中,低和极低容量中心与死亡率增加独立相关。

结论

年度病例数的最佳截止点是 20 次胰腺切除术。胰十二指肠切除术后 POM 在独立于 ChCl 的低容量中心和非常低容量中心较高,表明该程序应集中进行。

更新日期:2019-11-26
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