胰腺外科的量效关系：德国的情况。

Volume-outcome relationship in pancreatic surgery: the situation in Germany.

机构信息

Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Rostock, Germany.

出版信息

Surgery. 2012 Sep;152(3 Suppl 1):S50-5. doi: 10.1016/j.surg.2012.05.011. Epub 2012 Jul 3.

DOI:10.1016/j.surg.2012.05.011

PMID:22763260

Abstract

BACKGROUND

Discussion of the volume-outcome relationship in pancreatic surgery has gained increasing interest. Currently, no data describe the situation in Germany. Pursuant to a recent legislative reform, a threshold of 10 operations per year was introduced for pancreatic surgery in 2006. This study describes the situation in Germany and the effect of the legislative reform between 2006 and 2009.

METHODS

In 2007 and 2010, anonymous questionnaires were sent to leading surgeons in the German Society of General and Gastrointestinal Surgery asking for the numbers of pancreatic operations, methods of operation, and mortality for the years 2006, 2008, and 2009. Volume categories were defined by dividing hospitals into quartiles according to their annual volume of operations.

RESULTS

The return rate was about 48%. In the years 2006, 2008, and 2009, overall mortality in all hospitals was 2.85%, 3.98%, and 2.58%. High volume was defined as ≥ 32 pancreatic operations (2006) and ≥ 34 pancreatic operations (2008, 2009). Although mortality decreased with increasing volume, mortality between each volume category was not statistically different in any year. In the years 2006, 2008, and 2009, the number of operations increased in university hospitals (38.4%, 51.2%, and 50.4%, P < .001) and decreased in teaching hospitals (51.8%, 41.3%, and 41.2%, P < .001). The number of hospitals that did not perform pancreatic operations increased from 15.6% to 32.5% and 31% (P < .001).

CONCLUSION

In pancreatic surgery, a centralization effect occurred after a legislative reform in Germany. Overall mortality after pancreatic resection in German hospitals is good. Although mortality decreases with greater volume, there were no differences compared to other volume categories. Also, low-volume hospitals can produce good results; however, the difference in quality is considerable among these institutions. Our data suggest that the German threshold agreement in pancreatic surgery might have a positive effect with regard to reproducible quality and outcome.

摘要

背景

有关胰腺外科手术量-效果关系的讨论引起了越来越多的关注。目前，尚无数据描述德国的情况。根据最近的立法改革，2006 年规定胰腺外科手术的最低门槛为每年 10 例。本研究描述了德国的情况以及 2006 年至 2009 年立法改革的效果。

方法

2007 年和 2010 年，向德国普通和胃肠外科学会的主要外科医生发送了匿名问卷，要求他们提供 2006 年、2008 年和 2009 年的胰腺手术数量、手术方法和死亡率。根据医院每年的手术量，将医院分为四组。

结果

回复率约为 48%。在所有医院中，2006 年、2008 年和 2009 年的总死亡率分别为 2.85%、3.98%和 2.58%。高容量定义为≥32 例胰腺手术（2006 年）和≥34 例胰腺手术（2008 年和 2009 年）。尽管随着手术量的增加死亡率有所下降，但在任何一年，各手术量组之间的死亡率均无统计学差异。在 2006 年、2008 年和 2009 年，大学医院的手术数量增加（38.4%、51.2%和 50.4%，P<.001），教学医院的手术数量减少（51.8%、41.3%和 41.2%，P<.001）。不开展胰腺手术的医院数量从 15.6%增加到 32.5%和 31%（P<.001）。

结论

在德国的立法改革后，胰腺外科手术出现了集中化效应。德国医院胰腺切除术后的总体死亡率良好。尽管随着手术量的增加死亡率有所下降，但与其他手术量组相比，无差异。此外，低手术量医院也可以取得良好的效果；但是，这些机构之间的质量差异相当大。我们的数据表明，德国的胰腺手术门槛协议可能会对可重复的质量和结果产生积极影响。