Depts of Statistics and Mathematics for Real World Systems CDT, University of Warwick, UK.
Department of Informatics, University Hospitals Birmingham, UK.
HPB (Oxford). 2018 Nov;20(11):1012-1020. doi: 10.1016/j.hpb.2018.04.008. Epub 2018 Jun 9.
Mortality following pancreatoduodenectomy is related to centre volume although the optimal volume is not defined.
Patients undergoing PD between 2001 and 2016 were identified from UK national databases. The effects of patient variables, centre volume and time period upon 90 day mortality were studied.
90 day mortality (970/14,935, 6.5%) was related to advanced age, comorbidity, diagnosis, ethnicity, deprivation, centre volume and time period. Mortality rates fell markedly from 10.0% in 2001-4 to 4.1% in 2013-16. There was no difference in 90 day mortality between high (36 -60 PD per year) and very high volume (>60) centres. However, patients operated upon at very high volume centres were more elderly (66, 58 -73 vs 65, 56 -72; median, IQR; p = 0.006), deprived (38.7 vs 34.6%; p < 0.001) and co morbid (48.9 vs 46.1%; p = 0.027).
Although a plateau in the centre volume and mortality relationship appears to have been demonstrated those patients treated at the highest volume centres were at higher risk of mortality. This data suggests therefore that to further understand outcomes from specialist centres characteristics of the patient population should be defined, not just centre volume.
胰十二指肠切除术（PD）后的死亡率与中心手术量有关，但最佳手术量尚未确定。
从英国国家数据库中确定了 2001 年至 2016 年间接受 PD 的患者。研究了患者变量、中心手术量和时间段对 90 天死亡率的影响。
90 天死亡率（970/14935，6.5%）与年龄较大、合并症、诊断、种族、贫困、中心手术量和时间段有关。死亡率从 2001-2004 年的 10.0%显著下降至 2013-2016 年的 4.1%。高（36-60 例/年）和超高（>60 例）手术量中心之间的 90 天死亡率无差异。然而，在超高手术量中心接受手术的患者年龄更大（66 岁，58-73 岁 vs 65 岁，56-72 岁；中位数，IQR；p=0.006），贫困（38.7%vs34.6%；p<0.001）和合并症（48.9%vs46.1%；p=0.027）更多。
尽管中心手术量与死亡率之间似乎已经出现了平台期，但在最高手术量中心接受治疗的患者死亡风险更高。因此，该数据表明，要进一步了解专科中心的结果，不仅要定义中心手术量，还应定义患者人群的特征。
