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利用 ACS-NSQIP、风琴式严重程度分级系统和术后并发症指数，为胰十二指肠切除术建立发病率的定量基准。

Establishing a quantitative benchmark for morbidity in pancreatoduodenectomy using ACS-NSQIP, the Accordion Severity Grading System, and the Postoperative Morbidity Index.

机构信息

*Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA †Department of Surgery, Washington University School of Medicine in St Louis, St Louis, MO ‡Olin Business School and the Center for Health Policy, Washington University in St Louis, St Louis, MO; Department of Surgery, BJC Healthcare, St Louis, MO §Department of Surgery, Columbia University School of Medicine, New York, NY ‖Department of Surgery, Indiana University School of Medicine, Indianapolis, IN ¶Department of Surgery, University of Tennessee Health Science Center, Memphis, TN **Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA ††Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, AL ‡‡Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD §§Department of Surgery, Temple University School of Medicine, Philadelphia, PA; and ¶¶Department of Surgery, University of Wisconsin School of Medicine, Madision, WI.

出版信息

Ann Surg. 2015 Mar;261(3):527-36. doi: 10.1097/SLA.0000000000000843.

DOI:10.1097/SLA.0000000000000843

PMID:25268299

Abstract

OBJECTIVE

The study aim was to quantify the burden of complications of pancreatoduodenectomy (PD).

BACKGROUND

The Postoperative Morbidity Index (PMI) is a quantitative measure of the average burden of complications of a procedure. It is based on highly validated systems--ACS-NSQIP and the Modified Accordion Severity Grading System.

METHODS

Nine centers contributed ACS-NSQIP complication data for 1589 patients undergoing PD from 2005 to 2011. Each complication was assigned a severity weight ranging from 0.11 for the least severe complication to 1.00 for postoperative death, and PMI was derived. Contribution to total burden by each complication grade was used to generate a severity profile ("spectrogram") for PD. Associations with PMI were determined by regression analysis.

RESULTS

ACS-NSQIP complications occurred in 528 cases (33.2%). The non-risk-adjusted PMI was 0.115 (SD = 0.023) for all centers and 0.113 (SD = 0.005) for the 7 centers that contributed at least 100 cases. Grade 2 complications were predominant in frequency, and the most common complication was postoperative bleeding/transfusion. Frequency and burden of complications differed markedly. For instance, severe complications (grades 4/5/6) accounted for only about 20% of complications but for more than 40% of the burden of complications. Organ space infection had the highest burden of any complication. The average burden in cases in which a complication actually occurred was 0.346.

CONCLUSIONS

This study develops a quantitative non-risk-adjusted benchmark for postoperative morbidity of PD. The method quantifies the burden of types and grades of postoperative complications and should prove useful in identifying areas that require quality improvement.

摘要

目的

研究旨在量化胰十二指肠切除术（PD）并发症的负担。

背景

术后发病率指数（PMI）是衡量手术并发症平均负担的定量指标。它基于高度验证的系统——美国外科医师学会国家外科质量改进计划（ACS-NSQIP）和改良风琴严重程度分级系统。

方法

9 个中心提供了 2005 年至 2011 年间 1589 例接受 PD 的患者的 ACS-NSQIP 并发症数据。每个并发症都被分配了一个严重程度权重，从最轻微的并发症（0.11）到术后死亡（1.00）不等，然后计算出 PMI。每个并发症等级对总负担的贡献用于生成 PD 的严重程度谱（“光谱图”）。通过回归分析确定与 PMI 的关联。

结果

ACS-NSQIP 并发症发生在 528 例（33.2%）中。所有中心的非风险调整 PMI 为 0.115（SD=0.023），至少贡献 100 例的 7 个中心的 PMI 为 0.113（SD=0.005）。2 级并发症的发生率最高，最常见的并发症是术后出血/输血。并发症的频率和负担差异很大。例如，严重并发症（4/5/6 级）仅占并发症的 20%左右，但占并发症负担的 40%以上。器官空间感染是任何并发症中负担最重的。实际上发生并发症的病例的平均负担为 0.346。