Department of Surgery, University of South Carolina, Greenville Health System, 701 Grove Road, Greenville, SC 29605, USA.
Division of Surgical Oncology, Brody School of Medicine, East Carolina University, Greenville, NC, USA.
J Hepatobiliary Pancreat Sci. 2019 May;26(5):187-194. doi: 10.1002/jhbp.621. Epub 2019 Apr 8.
We sought to determine treatment outcomes after pancreatoduodenectomy for pancreatic head and uncinate process malignancy and its impact on mortality, morbidity, and resource utilization.
This was a retrospective cohort study using the 2014 Nationwide Readmissions Database. Discharges were included if they had an ICD-9 CM procedure code for pancreatoduodenectomy and any code for malignancy of the pancreas head and uncinate process. Independent predictors of readmission were identified using multivariable Cox regression analysis.
A total of 4,445 patients were included. The surgical complication rate was 17.3%, and in-hospital mortality rate was 3%. The 30-day readmission rate was 19.7% with an in-hospital mortality rate of 3.9%. The most common reason for readmission was postoperative infection. The mean length of stay during readmission was 6.50 days, while the mean total hospitalization costs and charges were $15,589 and $52,922, respectively. The number of hospital days associated with readmission was 5,548, with an in-hospital economic burden of $12.9 million (costs) and $43.7 million (charges). Hospital volume and discharge disposition were independent predictors of 30-day readmission.
Pancreatoduodenectomy for pancreatic malignancies is still associated with significant morbidity, mortality and 30-day readmission. Reducing readmission can impact mortality, quality of life, and healthcare economic burden in this setting.
我们旨在确定胰头和钩突恶性肿瘤胰十二指肠切除术的治疗结果及其对死亡率、发病率和资源利用的影响。
这是一项使用 2014 年全国再入院数据库的回顾性队列研究。如果出院记录有胰十二指肠切除术的 ICD-9-CM 程序代码和任何胰头和钩突恶性肿瘤代码，则纳入研究。使用多变量 Cox 回归分析确定再入院的独立预测因素。
共纳入 4445 例患者。手术并发症发生率为 17.3%，院内死亡率为 3%。30 天再入院率为 19.7%，院内死亡率为 3.9%。再入院的主要原因是术后感染。再入院期间的平均住院时间为 6.50 天，平均总住院费用和费用分别为 15589 美元和 52922 美元。与再入院相关的住院天数为 5548 天，院内经济负担为 1290 万美元（成本）和 4370 万美元（费用）。医院容量和出院处置是 30 天再入院的独立预测因素。
胰头和钩突恶性肿瘤的胰十二指肠切除术仍然与显著的发病率、死亡率和 30 天再入院率相关。减少再入院可影响该人群的死亡率、生活质量和医疗保健经济负担。
