Gódi Szilárd, Erőss Bálint, Gyömbér Zsuzsanna, Szentesi Andrea, Farkas Nelli, Párniczky Andrea, Sarlós Patrícia, Bajor Judit, Czimmer József, Mikó Alexandra, Márta Katalin, Hágendorn Roland, Márton Zsolt, Verzár Zsófia, Czakó László, Szepes Zoltán, Vincze Áron, Hegyi Péter
1st Department of Medicine, University of Pécs Medical School, 7624 Pécs, Hungary.
1st Department of Medicine, University of Pécs Medical School; Institute for Translational Medicine, University of Pécs Medical School, 7624 Pécs, Hungary.
J Gastrointestin Liver Dis. 2018 Jun;27(2):151-157. doi: 10.15403/jgld.2014.1121.272.pan.
In this observational study, we investigated whether specialized care improves outcomes for acute pancreatitis (AP).
Consecutive patients admitted to two university hospitals with AP were enrolled in this study between 1 January 2016 and 31 December 2016 (Center A: specialized center; Center B: general hospital). Data on demographic characteristics and AP etiology, severity, mortality and quality of care (enteral nutrition and antibiotic use) were extracted from the Hungarian Acute Pancreatitis Registry. An independent sample t-test, Mann-Whitney test, chi-squared test or Fisher's test were used for statistical analyses. Costs of care were calculated and compared in the two models of care.
There were 355 patients enrolled, 195 patients in the specialized center (Center A) and 160 patients in the general hospital (Center B). There was no difference in mean age (57.02 +/-17.16 vs. 57.31 +/-16.50 P=0.872) and sex ratio (56% males vs. 57% males, P=0.837) between centres, allowing a comparison without selection bias. Center A had lower mortality (n=2, 1.03% vs. n=16, 6.25%, p=0.007), more patients received enteral feeding (n=179, 91.8%, vs. n=36, 22.5%, p<0.001) and fewer patients were treated with antibiotics (n=85, 43.6% vs. n=123, 76.9%, p=0.001). In Center A the median length of hospitalization was shorter (Me 6, IQR 5-9 vs. Me 8, IQR 6-11, p=0.02) and the costs of care were by 25% lower.
Our data suggests that treatment of AP in specialized centers reduces mortality, length of hospitalization and thus might reduce the costs.
在这项观察性研究中，我们调查了专科护理是否能改善急性胰腺炎（AP）的治疗结果。
2016年1月1日至2016年12月31日期间，连续入住两家大学医院的AP患者被纳入本研究（中心A：专科中心；中心B：综合医院）。从匈牙利急性胰腺炎登记处提取有关人口统计学特征、AP病因、严重程度、死亡率和护理质量（肠内营养和抗生素使用）的数据。采用独立样本t检验、曼-惠特尼检验、卡方检验或费舍尔检验进行统计分析。计算并比较两种护理模式下的护理成本。
共纳入355例患者，专科中心（中心A）195例，综合医院（中心B）160例。中心之间的平均年龄（57.02±17.16对57.31±16.50，P=0.872）和性别比例（男性56%对男性57%，P=0.837）无差异，可进行无选择偏倚的比较。中心A的死亡率较低（n=2，1.03%对n=16，6.25%，p=0.007），更多患者接受肠内喂养（n=179，91.8%对n=36，22.5%，p<0.001），接受抗生素治疗的患者较少（n=85，43.6%对n=123，76.9%，p=0.001）。在中心A，住院时间中位数较短（中位数6，四分位间距5-9对中位数8，四分位间距6-11，p=0.02），护理成本低25%。
我们的数据表明，在专科中心治疗AP可降低死亡率、缩短住院时间，从而可能降低成本。
