Schwarz Lilian, Bruno Morgan, Parker Nathan H, Prakash Laura, Mise Yoshihiro, Lee Jeffrey E, Vauthey Jean-Nicolas, Aloia Thomas A, Conrad Claudius, Fleming Jason B, Katz Matthew H G
Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX, USA.
Ann Surg Oncol. 2015 Oct;22(11):3522-9. doi: 10.1245/s10434-015-4437-z. Epub 2015 Feb 19.
The rate of adverse events after pancreatectomy is widely reported as a measure of surgical quality. However, morbidity data are routinely acquired retrospectively and often are reported at 30 days. The authors hypothesized that morbidity after pancreatectomy is therefore underreported. They sought to compare rates of adverse events calculated at multiple time points after pancreatectomy.
The authors instituted an active surveillance system to detect, categorize, and grade the severity of all adverse events after pancreatectomy, using the modified Accordion system and International Study Group of Pancreatic Surgery definitions. All patients and clinical events were monitored directly for at least 90 days after surgery.
Of 315 consecutively monitored patients, 239 (76 %) experienced 500 unique adverse events. The absolute number of unique adverse events increased by 32 % between index discharge and 90 days and by 10 % between 30 and 90 days. The number of severe adverse events increased by 96 % between discharge and 90 days and by 29 % between 30 and 90 days. In this study, 16 % of the patients experienced at least one severe adverse event within the index hospitalization, 24 % within 30 postoperative days, and 29 % within 90 days. Among the 80 readmissions that occurred within 90 days, 28 (35 %) occurred later than 30 days after pancreatectomy.
Approximately one-third of severe adverse events and readmissions are reported more than 30 days after surgery. All adverse events that occur within 90 days of surgery must be identified and reported for accurate characterization of the morbidity associated with pancreatectomy.
胰腺切除术后不良事件发生率被广泛报道，作为衡量手术质量的一项指标。然而，发病率数据通常是通过回顾性收集的，且常常报告的是术后30天的数据。作者推测，胰腺切除术后的发病率因此被低估了。他们试图比较胰腺切除术后多个时间点计算出的不良事件发生率。
作者建立了一个主动监测系统，使用改良的手风琴系统和国际胰腺手术研究组的定义，来检测、分类和分级胰腺切除术后所有不良事件的严重程度。所有患者和临床事件在术后至少90天内进行直接监测。
在315例连续监测的患者中，239例（76%）发生了500起不同的不良事件。从出院时到90天，不同不良事件的绝对数量增加了32%，从30天到90天增加了10%。严重不良事件的数量从出院时到90天增加了96%，从30天到90天增加了29%。在本研究中，16%的患者在首次住院期间发生了至少1起严重不良事件，24%在术后30天内发生，29%在90天内发生。在90天内发生的80次再入院中，28次（35%）发生在胰腺切除术后30天之后。
约三分之一的严重不良事件和再入院发生在术后30天之后才被报告。必须识别并报告手术90天内发生的所有不良事件，以便准确描述与胰腺切除术相关的发病率。
