手术专长的集中是否能改善腹腔镜胆囊切除术的结果？9 年审核周期。

Does concentration of surgical expertise improve outcomes for laparoscopic cholecystectomy? 9 year audit cycle.

机构信息

Royal Devon and Exeter Foundation Trust, Barrack Road, Exeter, Devon EX2 5DW, UK.

出版信息

Surgeon. 2013 Dec;11(6):309-12. doi: 10.1016/j.surge.2013.06.005. Epub 2013 Jul 31.

DOI:10.1016/j.surge.2013.06.005

PMID:23916664

Abstract

BACKGROUND

Evidence from surgery shows that high volume is often associated with better outcomes. The aim of this study was to investigate this principle related to elective laparoscopic cholecystectomy practice.

METHODS

A retrospective analysis of all conversions and complications for patients undergoing elective laparoscopic cholecystectomy was performed. Data was collected and then repeated after restrictions were implemented to concentrate practice. Hospital databases and patient notes were used to collect data.

RESULTS

Between January 1999 and March 2004, 1605 laparoscopic cholecystectomies were performed by 8 surgeons. Case load varied from an average of <1 to 104 procedures per annum. Only 1 surgeon was an upper gastrointestinal specialist. Overall rates for conversion to open surgery were 4.9%, common bile duct injury was 0.31%, bile leak 0.75%, bowel injury 0.25%, haemorrhage 0.44% and death 0.06%, which met guidelines. Significant correlation between conversion and procedure number was identified (p=0.033) Between April 2006 and March 2010, 1820 laparoscopic cholecystectomies were performed by 4 surgeons. Case load varied from 23 to 268 procedures per annum, 2 surgeons were upper gastrointestinal specialists. Overall rates for conversion to open surgery were 3.5%, common bile duct injury 0.1%, bile leak 0.9%, bowel injury 0.21%, haemorrhage 0.16% and death 0.1%. Conversion rates were significantly lower in re-audit data (p=0.027), but remained lowest for the highest volume sub-specialist surgeons (p=0.016).

CONCLUSIONS

Concentrating expertise to those surgeons with interest and commitment to laparoscopic cholecystectomy service led to standardisation and reduction in conversion rates. There is correlation between volume of surgery and outcomes.

摘要

背景

手术证据表明，高容量通常与更好的结果相关。本研究旨在调查与选择性腹腔镜胆囊切除术实践相关的这一原则。

方法

对所有接受选择性腹腔镜胆囊切除术的患者的中转和并发症进行回顾性分析。收集数据后，实施限制措施集中实践，然后再次收集数据。使用医院数据库和患者记录收集数据。

结果

1999 年 1 月至 2004 年 3 月，8 名外科医生进行了 1605 例腹腔镜胆囊切除术。病例量平均每年<1 至 104 例不等。只有 1 名外科医生是上消化道专家。中转开腹手术的总体比率为 4.9%，胆总管损伤率为 0.31%，胆漏率为 0.75%，肠损伤率为 0.25%，出血率为 0.44%，死亡率为 0.06%，符合指南。发现中转与手术数量之间存在显著相关性（p=0.033）。2006 年 4 月至 2010 年 3 月，4 名外科医生进行了 1820 例腹腔镜胆囊切除术。病例量每年从 23 例到 268 例不等，其中 2 名外科医生是上消化道专家。中转开腹手术的总体比率为 3.5%，胆总管损伤率为 0.1%，胆漏率为 0.9%，肠损伤率为 0.21%，出血率为 0.16%，死亡率为 0.1%。再次审核数据中转率显著降低（p=0.027），但最高容量亚专科医生的中转率最低（p=0.016）。