Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
Department of Surgery, Wexner Medical Center at The Ohio State University, Columbus, OH, USA.
J Gastrointest Surg. 2018 Nov;22(11):1911-1919. doi: 10.1007/s11605-018-3834-6. Epub 2018 Jun 25.
While minimally invasive approaches are increasingly being utilized for pancreatoduodenectomy (PD), factors associated with prolonged operative time (OpTime) and hospital length of stay (LOS) remain poorly defined, and it is unclear whether these factors are consistent across surgical approaches.
The ACS-NSQIP targeted pancreatectomy database from 2014 to 2016 was used to identify all patients who underwent open (OPD), laparoscopic (LPD), or robotic (RPD) pancreatoduodenectomy. Multivariable linear regression analyses were used to evaluate predictors of OpTime and LOS, as well as quantify the changes observed relative to each surgical approach.
Among 10,970 patients, PD procedure types varied: 9963 (92%) open, 418 (4%) laparoscopic, and 409 (4%) robotic. LOS was longer for the open and laparoscopic approaches (11 vs. 11 vs. 10 days, P = 0.0068), whereas OpTime was shortest for OPD (366 vs. 426 vs. 435 min, P < 0.0001). Independent predictors of a prolonged OpTime were ASA class ≥ 3 (P = 0.0002), preoperative XRT (P < 0.0001), pancreatic duct < 3 mm (P = 0.0001), T stage ≥ 3 (P = 0.0108), and vascular resection (P < 0.0001) for OPD; T stage ≥ 3 (P = 0.0510) and vascular resection (P = 0.0062) for LPD; and malignancy (P = 0.0460) and conversion to laparotomy (P = 0.0001) for RPD. Independent predictors of increased LOS were age ≥ 65 years (P = 0.0002), ASA class ≥ 3 (P = 0.0012), hypoalbuminemia (P < 0.0001), and preoperative blood transfusion (P < 0.0001) for OPD as well as an OpTime > 370 min (all p < 0.05) and specific postoperative complications (all p < 0.05) for all surgical approaches.
Perioperative risk factors for prolonged OpTime and hospital LOS are relatively consistent across open, laparoscopic, and robotic approaches to PD. Particular attention to these factors may help identify opportunities to improve perioperative quality, enhance patient satisfaction, and ensure an efficient allocation of hospital resources.
虽然微创方法越来越多地应用于胰十二指肠切除术（PD），但与手术时间延长（OpTime）和住院时间延长（LOS）相关的因素仍定义不明确，并且不清楚这些因素是否在不同的手术方法中一致。
使用 2014 年至 2016 年 ACS-NSQIP 靶向胰腺切除术数据库，确定所有接受开放（OPD）、腹腔镜（LPD）或机器人（RPD）胰十二指肠切除术的患者。使用多变量线性回归分析评估 OpTime 和 LOS 的预测因素，并量化相对于每种手术方法观察到的变化。
在 10970 例患者中，PD 手术类型有所不同：9963 例（92%）为开放，418 例（4%）为腹腔镜，409 例（4%）为机器人。开放和腹腔镜方法的 LOS 较长（分别为 11 天、11 天和 10 天，P=0.0068），而 OPD 的 OpTime 最短（分别为 366 分钟、426 分钟和 435 分钟，P<0.0001）。OpTime 延长的独立预测因素包括 ASA 分级≥3（P=0.0002）、术前放疗（P<0.0001）、胰管<3mm（P=0.0001）、T 期≥3（P=0.0108）和血管切除（P<0.0001）用于 OPD；T 期≥3（P=0.0510）和血管切除（P=0.0062）用于 LPD；以及恶性肿瘤（P=0.0460）和转为剖腹手术（P=0.0001）用于 RPD。LOS 延长的独立预测因素包括年龄≥65 岁（P=0.0002）、ASA 分级≥3（P=0.0012）、低白蛋白血症（P<0.0001）和术前输血（P<0.0001）用于 OPD，以及 OpTime>370 分钟（均 P<0.05）和所有手术方法的特定术后并发症（均 P<0.05）。
开放、腹腔镜和机器人 PD 方法中，手术时间延长和住院时间延长的围手术期危险因素相对一致。特别关注这些因素可能有助于确定改善围手术期质量、提高患者满意度和确保有效分配医院资源的机会。
