Section of General Thoracic Surgery, Virginia Mason Medical Center, Seattle, WA 98111, USA.
J Am Coll Surg. 2012 Sep;215(3):331-6. doi: 10.1016/j.jamcollsurg.2012.04.030. Epub 2012 Jun 8.
The ability to assess and compare the impact of postoperative complications in major cancer surgery is currently limited. The Accordion Severity Grading System provides the opportunity to categorize complications according to treatment responses and resource use.
A retrospective review of patient demographics, perioperative outcomes, and costs was performed using a prospective IRB-approved database of patients undergoing esophagectomy from 2000 to 2008.
This study included 285 consecutive patients, 83% were male, and mean age was 63.7 years. Histology was predominantly adenocarcinoma (80%). For patients with invasive cancer, overall survival at 5 years was 50%. Mean overall cost and length of stay were $23,419 and 10.4 days, respectively. Neoadjuvant therapy was used in 156 patients (54.7%) and operative mortality rate was 0.7%. Complications were documented in 144 patients (50.5%), with Accordion grades assigned as 1 (29%), 2 (59%), 3 (3%), 4 (6%), 5 (2%), and 6 (0.7%). Accordion grade was significantly related to costs and length of stay in univariate (p < 0.005) and multivariate analyses (p < 0.005). There was a statistically significant difference in survival between those patients who did and did not experience complications; however, no significant differences were noted among individual Accordion grades. Cox regression multivariate analysis demonstrated a significant relationship between overall survival and occurrence of postoperative complications.
The Accordion Severity Grading System provides a meaningful approach to classifying complications according to resource use, which also directly correlates with treatment costs and length of stay. Survival is affected by overall occurrence of complications, but was not related to individual Accordion grades in this study. The Accordion Severity Grading System should be a component of prospective data collections and can be used in major cancer surgery to study areas appropriate for quality improvement and cost containment.
目前评估和比较重大癌症手术后并发症影响的能力有限。Accordion 严重程度分级系统提供了根据治疗反应和资源使用对并发症进行分类的机会。
对 2000 年至 2008 年接受食管癌切除术的患者的人口统计学、围手术期结果和成本进行了回顾性审查，使用了经 IRB 批准的前瞻性数据库。
这项研究包括 285 例连续患者，83%为男性，平均年龄为 63.7 岁。组织学主要为腺癌（80%）。对于浸润性癌症患者，5 年总体生存率为 50%。平均总费用和住院时间分别为 23419 美元和 10.4 天。156 例（54.7%）患者接受了新辅助治疗，手术死亡率为 0.7%。144 例（50.5%）患者记录了并发症，Accordion 分级分别为 1 级（29%）、2 级（59%）、3 级（3%）、4 级（6%）、5 级（2%）和 6 级（0.7%）。Accordion 分级在单变量（p<0.005）和多变量分析（p<0.005）中与成本和住院时间显著相关。有并发症和无并发症患者的生存存在统计学差异；然而，在各个 Accordion 分级之间没有发现显著差异。Cox 回归多变量分析表明，总体生存率与术后并发症的发生有显著关系。
Accordion 严重程度分级系统为根据资源使用对并发症进行分类提供了一种有意义的方法，这也与治疗成本和住院时间直接相关。本研究中，生存受到总体并发症发生的影响，但与各个 Accordion 分级无关。Accordion 严重程度分级系统应成为前瞻性数据收集的一个组成部分，并可用于重大癌症手术，以研究适合质量改进和成本控制的领域。
