Department of Surgery, Virginia Commonwealth University, 1200 E. Broad St, PO Box 980011, Richmond, VA, 23298, USA.
Department of Surgery, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
J Gastrointest Surg. 2018 Jun;22(6):998-1006. doi: 10.1007/s11605-018-3700-6. Epub 2018 Feb 5.
Readmissions are a common complication after pancreaticoduodenectomy and are increasingly being used as a performance metric affecting quality assessment, public reporting, and reimbursement. This study aims to identify general and pancreatectomy-specific factors contributing to 30-day readmission after pancreaticoduodenectomy, and determine the additive value of incorporating pancreatectomy-specific factors into a large national dataset.
Prospective American College of Surgeons-National Surgical Quality Improvement Project (ACS-NSQIP) data were retrospectively analyzed for patients who underwent pancreaticoduodenectomy (PD) between 2011 and 2015. Additionally, a subset of patients with pancreatectomy-targeted data between 2014 and 2015 were analyzed.
Outcomes of 18,440 pancreaticoduodenectomies were analyzed, and found to have an 18.7% overall readmission rate. Multivariable modeling with pancreatectomy-specific variables increased the predictive value of the model (area under receiver operator characteristic 0.66 to 0.73). Statistically significant independent contributors to readmission included renal insufficiency, sepsis, septic shock, organ space infection, dehiscence, venous thromboembolism, pancreatic fistula, delayed gastric emptying, need for percutaneous drainage, and reoperation.
Large registry analyses of pancreatectomy outcomes are markedly improved by the incorporation of granular procedure-specific data. These data emphasize the need for prevention and careful management of perioperative infectious complications, fluid management, thromboprophylaxis, and pancreatic fistulae.
胰十二指肠切除术（pancreaticoduodenectomy，PD）后再入院是一种常见并发症，它越来越多地被用作影响质量评估、公共报告和报销的绩效指标。本研究旨在确定导致 PD 术后 30 天再入院的一般因素和胰腺切除术特异性因素，并确定将胰腺切除术特异性因素纳入大型国家数据集的附加价值。
回顾性分析了 2011 年至 2015 年间接受 PD 的美国外科医师学院-国家外科质量改进计划（American College of Surgeons-National Surgical Quality Improvement Project，ACS-NSQIP）前瞻性数据。此外，还分析了 2014 年至 2015 年具有胰腺切除术靶向数据的患者子集。
分析了 18440 例 PD 的结果，发现总体再入院率为 18.7%。使用具有胰腺切除术特异性变量的多变量模型增加了模型的预测值（接受者操作特征曲线下面积从 0.66 增加到 0.73）。再入院的独立显著因素包括肾功能不全、败血症、感染性休克、器官间隙感染、裂开、静脉血栓栓塞、胰瘘、胃排空延迟、需要经皮引流和再次手术。
通过纳入精细的手术特异性数据，对胰腺切除术结果的大型登记分析得到了显著改善。这些数据强调了预防和仔细管理围手术期感染性并发症、液体管理、血栓预防和胰瘘的必要性。
