Gastinger I, Meyer F, Shardin A, Ptok H, Lippert H, Dralle H
AN-Institut für Qualitätssicherung in der Operativen Medizin, Otto-von-Guericke-Universität Magdeburg, Magdeburg, Deutschland.
Klinik für Allgemein‑, Viszeral‑, Gefäß- und Transplantationschirurgie, Universitätsklinikum Magdeburg A.ö.R., Magdeburg, Deutschland.
Chirurg. 2019 Jan;90(1):47-55. doi: 10.1007/s00104-018-0654-x.
The rate of hospital mortality (in-hospital mortality) after complex pancreatic resections cannot be used as a decision-making criterion with no further analysis and specification. Such analysis has to provide a risk-adjusted benchmarking including a continuous evaluation taking into account the frequency of a surgical procedure and its competent perioperative management.
As part of the Prospective Evaluation study Elective Pancreatic surgery (PEEP), overall 2003 patients were enrolled over a 3-year time period from 01 January 2006 to 12 December 2008, who underwent elective pancreatic surgery in 27 surgical departments. Included in the study were only hospitals which perform pancreatic resections. In addition to the analysis of the current situation of the operative treatment of pancreatic diseases, the complex aspects of the in-hospital mortality as a main outcome parameter were investigated.
Out of all enrolled patients (n = 2003), 75 patients (3.7%) died during the hospital stay. In the group of 1045 patients with partial pancreaticoduodenectomy (PD), 43 patients did not survive the hospital stay (4.1%). Similarly, such low in-hospital mortality rates were observed after total pancreatoduodenectomy (3.8%) and after left-sided resection of the pancreas (1.9%). With respect to a univariate risk stratification, advanced age and an American Society of Anaesthesiologists (ASA) score of 3 and 4 had a significant impact on in-hospital mortality. Multivariate regression analysis within the PD group revealed an increased need for blood transfusions and a delay in oral feeding as factors closely associated with specific complications with a significant impact on in-hospital mortality. Significant differences in the in-hospital mortality rates were found when comparing hospital volume groups, such as 10-20 vs. >20 cases/year for the 831 Kausch-Whipple procedures for adenocarcinoma and chronic pancreatitis.
An adequate in-hospital mortality rate in the continuous benchmarking represents an acceptable quality level of structural and therapeutic predictions in pancreatic resections. The participation of surgical departments with complex oncosurgical interventions in clinical multicenter observational studies as a contribution to research on surgical care appears reasonable and recommendable since the results of such studies can provide a contribution to decision-making processes in daily surgical practice.
复杂胰腺切除术后的医院死亡率（住院死亡率）未经进一步分析和明确，不能用作决策标准。此类分析必须提供一个风险调整后的基准，包括持续评估，同时要考虑手术操作的频率及其围手术期的合理管理。
作为前瞻性评估研究“择期胰腺手术（PEEP）”的一部分，在2006年1月1日至2008年12月31日的3年时间里，共纳入了2003例患者，他们在27个外科科室接受了择期胰腺手术。该研究仅纳入了进行胰腺切除术的医院。除了分析胰腺疾病手术治疗的现状外，还对作为主要结局参数的住院死亡率的复杂情况进行了调查。
在所有纳入的患者（n = 2003）中，75例（3.7%）在住院期间死亡。在1045例行部分胰十二指肠切除术（PD）的患者组中，43例患者未存活至出院（4.1%）。同样，全胰十二指肠切除术后（3.8%）和胰腺左侧切除术后（1.9%）也观察到如此低的住院死亡率。关于单因素风险分层，高龄以及美国麻醉医师协会（ASA）评分为3分和4分对住院死亡率有显著影响。PD组的多因素回归分析显示，输血需求增加和经口进食延迟是与特定并发症密切相关的因素，对住院死亡率有显著影响。比较医院手术量分组时，发现住院死亡率存在显著差异，例如，对于831例因腺癌和慢性胰腺炎行考施 - 惠普尔手术的患者，每年手术量为10 - 20例与>20例的情况相比。
在持续的基准评估中适当的住院死亡率代表了胰腺切除术中结构和治疗预测的可接受质量水平。外科科室参与复杂肿瘤外科手术干预的临床多中心观察性研究，作为对外科护理研究做出的贡献，似乎是合理且值得推荐的，因为此类研究结果可为日常外科实践中的决策过程提供帮助。
