Satoi Sohei, Yamamoto Tomohisa, Motoi Fuyuhiko, Matsumoto Ippei, Yoshitomi Hideyuki, Amano Ryosuke, Tahara Munenori, Murakami Yoshiaki, Arimitsu Hidehito, Hirono Seiko, Sho Masayuki, Ryota Hironori, Ohtsuka Masayuki, Unno Michiaki, Takeyama Yoshifumi, Yamaue Hiroki
Department of Surgery Kansai Medical University Hirakata Japan.
Department of Surgery Tohoku University Graduate School of Medicine Sendai Japan.
Ann Gastroenterol Surg. 2018 Mar 25;2(3):212-219. doi: 10.1002/ags3.12066. eCollection 2018 May.
Institutional standardization in the perioperative management of distal pancreatectomy (DP) has not been evaluated in a multicenter setting. The aim of the present study was to assess the influence of institutional standardization on the development of postoperative complications after DP.
Data were collected from 1515 patients who underwent DP in 2006, 2010, and 2014 at 53 institutions in Japan. A standardized institution (SI) was defined as one that implemented ≥6 of 11 quality initiatives according to departmental policy. There were 541 patients in the SI group and 974 in the non-SI group. Clinical parameters were compared between groups. Risk factors for morbidity and mortality were assessed by logistic regression analysis with a mixed-effects model.
Proportion of patients who underwent DP in SI 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 (grade III/IV Clavien-Dindo; 22% vs 29%, respectively, clinically relevant postoperative pancreatic fistula; 22% vs 31%, respectively, < .05 for both). Duration of in-hospital stay in the SI group was significantly shorter than that in the non-SI group (16 [5-183] vs 20 postoperative days [5-204], respectively; = .002). Multivariate analysis with a mixed-effects model showed that soft pancreas, late drain removal, excess blood loss and long surgical time were risk factors for post-DP complications ( < .05). Pancreatic texture, drain management and surgical factors, but not standardization of care, were associated with a lower incidence of post-DP complications.
在多中心环境中，尚未对胰体尾切除术（DP）围手术期管理的机构标准化进行评估。本研究的目的是评估机构标准化对DP术后并发症发生的影响。
收集了2006年、2010年和2014年在日本53家机构接受DP的1515例患者的数据。标准化机构（SI）定义为根据部门政策实施了11项质量改进措施中≥6项的机构。SI组有541例患者，非SI组有974例患者。比较两组的临床参数。采用混合效应模型的逻辑回归分析评估发病和死亡风险因素。
SI组接受DP的患者比例从2006年的16.5%增加到2014年的46.4%。与非SI组相比，SI组的护理过程得到改善，严重并发症发生率更低（Clavien-Dindo III/IV级；分别为22%和29%，临床相关的术后胰瘘；分别为22%和31%，两者均P<0.05）。SI组的住院时间明显短于非SI组（分别为16天[5 - 183天]和术后20天[5 - 204天]；P = 0.002）。混合效应模型的多变量分析显示，胰腺质地软、引流管拔除延迟、失血过多和手术时间长是DP术后并发症的风险因素（P<0.05）。胰腺质地、引流管管理和手术因素，但不是护理标准化，与DP术后并发症发生率较低相关。
