Shahbazov Rauf, Naziruddin Bashoo, Yadav Kunal, Saracino Giovanna, Yoshimatsu Gumpei, Kanak Mazhar A, Beecherl Ernest, Kim Peter T, Levy Marlon F
Department of Surgery, University of Virginia, Charlottesville, VA, USA.
Baylor Annette C. and Harold C. Simmons Transplant Institute, Dallas-Fort Worth, TX, USA.
HPB (Oxford). 2018 Feb;20(2):166-174. doi: 10.1016/j.hpb.2017.08.033. Epub 2017 Oct 6.
Little published data exist examining causes of hospital readmission following total pancreatectomy with islet autotransplantation (TPIAT).
A retrospective analysis was performed of a prospectively collected institutional TPIAT database. Primary outcome was unplanned readmission to the hospital within 30 days from discharge. Reasons and risk factors for readmission as well as islet function were evaluated and compared by univariate and multivariate analysis.
83 patients underwent TPIAT from 2006 to 2014. 21 patients (25.3%) were readmitted within 30 days. Gastrointestinal problems (52.4%) and surgical site infection (42.8%) were the most common reasons for readmission. Initial LOS and reoperation were risk factors for early readmission. Patients with delayed gastric emptying (DGE) were three times more likely to get readmitted. In multivariate analysis, patients undergoing pylorus preservation surgery were nine times more likely to be readmitted than the antrectomy group.
Early readmission after TPIAT is common (one in four patients), underscoring the complexity of this procedure. Early readmission is not detrimental to islet graft function. Patients undergoing pylorus preservation are more likely to get readmitted, perhaps due to increased incidence of delayed gastric emptying. Decision for antrectomy vs. pylorus preservation needs to be individualized.
关于全胰切除联合胰岛自体移植（TPIAT）术后医院再入院原因的已发表数据较少。
对前瞻性收集的机构TPIAT数据库进行回顾性分析。主要结局是出院后30天内非计划再次入院。通过单因素和多因素分析评估并比较再入院的原因、危险因素以及胰岛功能。
2006年至2014年期间，83例患者接受了TPIAT。21例患者（25.3%）在30天内再次入院。胃肠道问题（52.4%）和手术部位感染（42.8%）是再入院最常见的原因。初始住院时间和再次手术是早期再入院的危险因素。胃排空延迟（DGE）患者再次入院的可能性是其他患者的三倍。在多因素分析中，接受保留幽门手术的患者再次入院的可能性是胃窦切除术组的九倍。
TPIAT术后早期再入院很常见（四分之一的患者），突出了该手术的复杂性。早期再入院对胰岛移植功能无害。接受保留幽门手术的患者更有可能再次入院，可能是由于胃排空延迟的发生率增加。胃窦切除术与保留幽门手术的决策需要个体化。
