Department of Surgery, Kansai Medical University, Hirakata, Osaka, Japan.
Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
J Hepatobiliary Pancreat Sci. 2017 Sep;24(9):501-510. doi: 10.1002/jhbp.492. Epub 2017 Sep 7.
The aim of the present study was to assess recent trends in pancreaticoduodenectomy (PD) and the role of institutional standardization on the development of postoperative complications in 3,378 patients who underwent PD in Japan.
Data were collected from 3,378 patients who underwent PD in 2006, 2010 and 2014 at 53 institutions. A standardized institution (SI) was defined as one that implements ≥7 of 13 quality initiatives according to departmental policy. There were 1,223 patients in the SI group and 2,155 in the non-SI group. Clinical parameters were compared over time, and between groups. Risk factors for morbidity and mortality were assessed by logistic regression analysis with a mixed-effects model.
The number of patients who underwent PD in SIs increased from 16.5% in 2006 to 46.4% in 2014. The SI group experienced an improved process of care and a lower frequency of severe complications vs. the non-SI group (P < 0.001). Multivariate analysis revealed that the SI group was associated with a lower incidence of delayed gastric emptying (odds ratio -0.499, P = 0.008) and incisional surgical site infection (odds ratio -0.999, P < 0.001).
Standardization of care in PD may be important in reducing post-PD complications, and is a critical element for improving clinical outcomes.
本研究旨在评估日本 3378 例行胰十二指肠切除术（PD）患者近期的趋势，以及机构标准化对术后并发症发展的影响。
从 2006 年、2010 年和 2014 年在 53 家机构接受 PD 的 3378 名患者中收集数据。标准化机构（SI）定义为根据部门政策实施≥7 项质量举措之一的机构。SI 组有 1223 名患者，非 SI 组有 2155 名患者。随着时间的推移和组间比较，比较临床参数。使用混合效应模型的逻辑回归分析评估发病率和死亡率的危险因素。
SI 中接受 PD 的患者数量从 2006 年的 16.5%增加到 2014 年的 46.4%。SI 组的护理过程得到改善，严重并发症的发生率低于非 SI 组（P<0.001）。多变量分析显示，SI 组与延迟胃排空（优势比-0.499，P=0.008）和切口手术部位感染（优势比-0.999，P<0.001）的发生率降低相关。
PD 护理的标准化对于降低 PD 后并发症可能很重要，并且是改善临床结果的关键要素。
