van Rijssen L Bengt, Koerkamp Bas G, Zwart Maurice J, Bonsing Bert A, Bosscha Koop, van Dam Ronald M, van Eijck Casper H, Gerhards Michael F, van der Harst Erwin, de Hingh Ignace H, de Jong Koert P, Kazemier Geert, Klaase Joost, van Laarhoven Cornelis J, Molenaar I Quintus, Patijn Gijs A, Rupert Coen G, van Santvoort Hjalmar C, Scheepers Joris J, van der Schelling George P, Busch Olivier R, Besselink Marc G
Department of Surgery, Academic Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands.
Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
HPB (Oxford). 2017 Oct;19(10):919-926. doi: 10.1016/j.hpb.2017.06.010. Epub 2017 Jul 26.
Auditing is an important tool to identify practice variation and 'best practices'. The Dutch Pancreatic Cancer Audit is mandatory in all 18 Dutch centers for pancreatic surgery.
Performance indicators and case-mix factors were identified by a PubMed search for randomized controlled trials (RCT's) and large series in pancreatic surgery. In addition, data dictionaries of two national audits, three institutional databases, and the Dutch national cancer registry were evaluated. Morbidity, mortality, and length of stay were analyzed of all pancreatic resections registered during the first two audit years. Case ascertainment was cross-checked with the Dutch healthcare inspectorate and key-variables validated in all centers.
Sixteen RCT's and three large series were found. Sixteen indicators and 20 case-mix factors were included in the audit. During 2014-2015, 1785 pancreatic resections were registered including 1345 pancreatoduodenectomies. Overall in-hospital mortality was 3.6%. Following pancreatoduodenectomy, mortality was 4.1%, Clavien-Dindo grade ≥ III morbidity was 29.9%, median (IQR) length of stay 12 (9-18) days, and readmission rate 16.0%. In total 97.2% of >40,000 variables validated were consistent with the medical charts.
The Dutch Pancreatic Cancer Audit, with high quality data, reports good outcomes of pancreatic surgery on a national level.
审计是识别实践差异和“最佳实践”的重要工具。荷兰胰腺癌审计在荷兰所有18个胰腺手术中心都是强制性的。
通过PubMed搜索胰腺手术的随机对照试验（RCT）和大型系列研究来确定性能指标和病例组合因素。此外，还评估了两项国家审计、三个机构数据库和荷兰国家癌症登记处的数据字典。分析了前两个审计年度登记的所有胰腺切除术的发病率、死亡率和住院时间。病例确定与荷兰医疗保健检查机构进行了交叉核对，并在所有中心对关键变量进行了验证。
发现了16项RCT和3个大型系列研究。审计中纳入了16项指标和20个病例组合因素。在2014 - 2015年期间，登记了1785例胰腺切除术，其中包括1345例胰十二指肠切除术。总体住院死亡率为3.6%。胰十二指肠切除术后，死亡率为4.1%，Clavien - Dindo≥III级发病率为29.9%，中位（IQR）住院时间为12（9 - 18）天，再入院率为16.0%。在>40,000个经过验证的变量中，总计97.2%与病历一致。
荷兰胰腺癌审计拥有高质量数据，在国家层面报告了胰腺手术的良好结果。
