腹腔镜结直肠手术培训中的风险预测评分：来自英国国家培训计划的经验。

Risk prediction score in laparoscopic colorectal surgery training: experience from the English National Training Program.

机构信息

*Department of Surgery and Cancer, St Mary's Hospital, Imperial College London, London, United Kingdom †John Golligher Colorectal Unit, The Leeds Teaching Hospitals, Leeds, United Kingdom ‡Department of Colorectal Surgery, Singapore General Hospital, Singapore §Department of Colorectal Surgery, University Hospitals Case Medical Center, Cleveland, OH; and ‖Department of Colorectal Surgery, Derriford Hospital, Plymouth, United Kingdom.

出版信息

Ann Surg. 2015 Feb;261(2):338-44. doi: 10.1097/SLA.0000000000000651.

DOI:10.1097/SLA.0000000000000651

PMID:24646565

Abstract

OBJECTIVE

The overall aim was to develop and validate a risk prediction score for laparoscopic colorectal surgery training cases.

BACKGROUND

Published risk prediction scores are not transferable between hospitals because they are derived from a single institution's data and are not designed for use in training situations.

METHODS

Cases from the prospectively collected database of the National Training Programme in Laparoscopic Colorectal Surgery, between July 2008 and July 2012, were analyzed. Independent risk factors for conversion were identified by the logistic regression. Converting the odds ratios into integers created a risk prediction score for conversion. The clinical impact of this score was investigated by comparing postoperative complications and the level of trainer input in high- and low-risk cases. To study whether adverse outcomes in predicted high-risk cases occur outside the National Training Programme in Laparoscopic Colorectal Surgery, 2 external data sets were examined.

RESULTS

A total of 2341 cases carried out in 42 hospitals were analyzed. Significant risk factors for conversion were body mass index, American Society of Anesthesiology classification, male sex, prior abdominal surgery, and resection type. At a risk score of more than 6, complication rates increased, including mortality (2.9% vs 0.5%, P < 0.001), anastomotic leak (4.3% vs 1.4%, P = 0.002), and a higher level of trainer input (32.2% vs 19.9% of cases, P < 0.001). Analysis of 786 external cases showed that high-risk cases had higher conversion (18.8% vs 7.1%, P < 0.001), overall complication (36.4% vs 15.0%, P < 0.001), and leak rates (4.0% vs 1.3%, P = 0.015).

CONCLUSIONS

A risk predication score to facilitate case selection in laparoscopic colorectal surgery training was developed and validated.

摘要

目的

本研究旨在开发并验证一种腹腔镜结直肠手术培训病例的风险预测评分。

背景

已发表的风险预测评分无法在医院间转移，因为它们是基于单家医院的数据得出的，并且不是为培训情况设计的。

方法

分析了 2008 年 7 月至 2012 年 7 月国家腹腔镜结直肠外科培训计划前瞻性收集的数据库中的病例。通过逻辑回归确定了手术中转的独立危险因素。将优势比转换为整数，创建了一个用于预测中转的风险预测评分。通过比较高危和低危病例的术后并发症和培训师的输入水平，研究了该评分的临床影响。为了研究预测高危病例的不良结局是否发生在国家腹腔镜结直肠外科培训计划之外，我们还检查了 2 个外部数据集。

结果

共分析了 42 家医院的 2341 例病例。手术中转的显著危险因素包括体重指数、美国麻醉医师协会分级、男性、既往腹部手术和切除类型。风险评分>6 分，并发症发生率增加，包括死亡率（2.9%比 0.5%，P<0.001）、吻合口漏（4.3%比 1.4%，P=0.002）和更高水平的培训师输入（32.2%比 19.9%的病例，P<0.001）。对 786 例外部病例的分析显示，高危病例中转（18.8%比 7.1%，P<0.001）、总并发症（36.4%比 15.0%，P<0.001）和漏口发生率（4.0%比 1.3%，P=0.015）更高。