Rosemurgy Alexander, Cowgill Sarah, Coe Brian, Thomas Ashley, Al-Saadi Sam, Goldin Steven, Zervos Emmanuel
Digestive Disorders Center, Tampa General Hospital, University of South Florida, Tampa, FL 33601, USA.
J Gastrointest Surg. 2008 Mar;12(3):442-9. doi: 10.1007/s11605-007-0442-2. Epub 2007 Dec 22.
This study was undertaken to determine changes in the frequency of, volume of, and outcomes after pancreaticoduodenectomy 6 years after a study denoted that, in Florida, the frequency and volume of pancreaticoduodenectomy impacted outcome.
Using the State of Florida Agency for Health Care Administration database, the frequency and volume of pancreaticoduodenectomy was correlated with average length of hospital stay (ALOS), in-hospital mortality, and hospital charges for identical periods in 1995-1997 and 2003-2005.
Compared to 1995-1997, 88% more pancreaticoduodenectomy was performed in 2003-2005 by 6% fewer surgeons; the majority of pancreaticoduodenectomies were conducted by surgeons doing <1 pancreaticoduodenectomy every 2 months. In-hospital mortality rate did not decrease from 1995-1997 to 2003-2005 (5.1 to 5.9%); in-hospital mortality rate increased for surgeons undertaking <1 pancreaticoduodenectomy every 2 months (5.5 to 12.3%, p<0.01). For 2003-2005, frequency with which pancreaticoduodenectomy is conducted inversely correlates with ALOS (p=0.001), hospital charges (p=0.001), and in-hospital mortality (p=0.001).
In Florida, more pancreaticoduodenectomies are carried out by fewer surgeons. Mortality has not decreased because of surgeons infrequently performing pancreaticoduodenectomy. Most pancreaticoduodenectomies are still undertaken by surgeons who conduct pancreaticoduodenectomy infrequently with greater lengths of stay, hospital costs, and in-hospital mortality rates. To an even greater extent than previously documented, patients are best served by surgeons frequently performing pancreaticoduodenectomy.
在一项研究表明在佛罗里达州胰十二指肠切除术的频率和手术量会影响手术结果6年后，本研究旨在确定胰十二指肠切除术后6年的手术频率、手术量及手术结果的变化。
利用佛罗里达州医疗保健管理局数据库，将1995 - 1997年和2003 - 2005年相同时间段内胰十二指肠切除术的频率和手术量与平均住院时间（ALOS）、院内死亡率及住院费用进行关联分析。
与1995 - 1997年相比，2003 - 2005年胰十二指肠切除术的实施例数增加了88%，而外科医生数量减少了6%；大多数胰十二指肠切除术由每2个月进行少于1例胰十二指肠切除术的外科医生实施。1995 - 1997年至2003 - 2005年期间，院内死亡率未下降（从5.1%至5.9%）；每2个月进行少于1例胰十二指肠切除术的外科医生的院内死亡率有所上升（从5.5%至12.3%，p<0.01）。对于2003 - 2005年，胰十二指肠切除术的实施频率与平均住院时间（p = 0.001）、住院费用（p = 0.001）及院内死亡率（p = 0.001）呈负相关。
在佛罗里达州，实施胰十二指肠切除术的外科医生数量减少，但手术例数增多。由于外科医生很少进行胰十二指肠切除术，死亡率并未下降。大多数胰十二指肠切除术仍由不常进行该手术的外科医生实施，这些手术会导致更长的住院时间、更高的住院费用及院内死亡率。与之前记录的情况相比，患者由经常进行胰十二指肠切除术的外科医生治疗效果最佳。
