Department of Surgery, Indiana University, Indianapolis, IN, USA.
HPB (Oxford). 2009 Aug;11(5):405-13. doi: 10.1111/j.1477-2574.2009.00074.x.
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was started in 2004. Presently, 58% of the 198 hospitals participating in ACS-NSQIP are academic or teaching hospitals. In 2008, ACS-NSQIP initiated a number of changes and made risk-adjusted data available for use by participating hospitals. This analysis explores the ACS-NSQIP database for utility in developing hepato-pancreato-biliary (HPB) surgery-specific outcomes (HPB-NSQIP).
The ACS-NSQIP Participant Use File was queried for patient demographics and outcomes for 49 HPB operations from 1 January 2005 through 31 December 2007. The procedures included six hepatic, 16 pancreatic and 23 complex biliary operations. Four laparoscopic or open cholecystectomy operations were also studied. Risk-adjusted probabilities for morbidity and mortality were compared with observed rates for each operation.
During this 36-month period, data were accumulated on 9723 patients who underwent major HPB surgery, as well as on 44,189 who received cholecystectomies. The major HPB operations included 2847 hepatic (29%), 5074 pancreatic (52%) and 1802 complex biliary (19%) procedures. Patients undergoing hepatic resections were more likely to have metastatic disease (42%) and recent chemotherapy (7%), whereas those undergoing complex biliary procedures were more likely to have significant weight loss (20%), diabetes (13%) and ascites (5%). Morbidity was high for hepatic, pancreatic and complex biliary operations (20.1%, 32.4% and 21.2%, respectively), whereas mortality was low (2.3%, 2.7% and 2.7%, respectively). Compared with laparoscopic cholecystectomy, the open operation was associated with higher rates of morbidity (19.2% vs. 6.0%) and mortality (2.5% vs. 0.3%). The ratios between observed and expected morbidity and mortality rates were <1.0 for hepatic, pancreatic and biliary operations.
These data suggest that HPB operations performed at ACS-NSQIP hospitals have acceptable outcomes. However, the creation of an HPB-NSQIP has the potential to improve quality, provide risk-adjusted registries with HPB-specific data and facilitate multi-institutional clinical trials.
美国外科医师学院国家外科质量改进计划（ACS-NSQIP）于 2004 年启动。目前，参与 ACS-NSQIP 的 198 家医院中有 58%是学术或教学医院。2008 年，ACS-NSQIP 进行了多项改革，并为参与医院提供了风险调整后数据。本分析利用 ACS-NSQIP 数据库开发肝胰胆（HPB）手术特定结局（HPB-NSQIP）。
查询 ACS-NSQIP 参与者使用文件，获取 2005 年 1 月 1 日至 2007 年 12 月 31 日期间 49 例 HPB 手术的患者人口统计学和结局数据。这些手术包括 6 例肝切除术、16 例胰切除术和 23 例复杂胆道手术。还研究了 4 例腹腔镜或开放胆囊切除术。将发病率和死亡率的风险调整概率与每种手术的观察率进行比较。
在这 36 个月期间，共收集了 9723 例接受主要 HPB 手术和 44189 例胆囊切除术患者的数据。主要 HPB 手术包括 2847 例肝切除术（29%）、5074 例胰切除术（52%）和 1802 例复杂胆道手术（19%）。行肝切除术的患者更有可能患有转移性疾病（42%）和近期化疗（7%），而行复杂胆道手术的患者更有可能出现显著体重减轻（20%）、糖尿病（13%）和腹水（5%）。肝、胰和复杂胆道手术的发病率较高（分别为 20.1%、32.4%和 21.2%），而死亡率较低（分别为 2.3%、2.7%和 2.7%）。与腹腔镜胆囊切除术相比，开放手术的发病率（19.2%比 6.0%）和死亡率（2.5%比 0.3%）更高。肝、胰和胆道手术的观察到的发病率和死亡率与预期发病率和死亡率的比值均<1.0。
这些数据表明，在 ACS-NSQIP 医院进行的 HPB 手术具有可接受的结局。然而，创建一个 HPB-NSQIP 有潜力改善质量，为 HPB 特定数据提供风险调整登记，并促进多机构临床试验。
