Department of Surgery, University of Pennsylvania Perelman School of Medicine, Philadelphia, PA, USA; Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, The Pancreas Institute, University of Verona Hospital Trust, Italy.
American College of Surgeons, Chicago, IL, USA; Department of Surgery, University of Chicago Medicine, Chicago, IL, USA.
HPB (Oxford). 2019 Dec;21(12):1773-1783. doi: 10.1016/j.hpb.2019.04.013. Epub 2019 May 29.
The association between higher surgical volume and better perioperative outcomes after pancreatectomy has been extensively demonstrated. However, how different notions of experience impact outcomes of surgeons operating within high-quality scenarios remains unclear.
Self-reported experience parameters from ACS-NSQIP HPB-Collaborative surgeons were merged with 2014-2016 ACS-NSQIP clinical data. The association of various experience parameters with outcomes was investigated through uni- and multivariable analyses. Hierarchical regression assessed surgeon performance.
111/151 HPB-Collaborative surgeons provided responses (73.5%). Compared to the other 532 ACS-NSQIP surgeons performing pancreatectomy, HPB-Collaborative surgeons performed 7692/16,239 of the overall pancreatectomies (47.3%), with improved outcomes of serious morbidity, pancreatic fistula, reoperation, duration of stay and readmissions. Median age of respondents was 49 years and 92.8% were fellowship-trained. Median career and annual pancreatectomy volume were 400 and 35, respectively; median annual institutional volume was 100 resections. On unadjusted analyses, several aspects of experience were associated with the outcomes studied, especially for pancreatoduodenectomy; however, none remained significant after multivariable adjustment. Surgeons' profiling showed substantial homogeneity in performance for both pancreatoduodenectomy and distal pancreatectomy.
Contemporary data shows that for surgeons operating in high quality settings clinical outcomes are largely independent of indicators of greater experience.
胰腺切除术术后更高的手术量与更好的围手术期结果之间的关联已得到广泛证明。然而，在高质量环境下操作的外科医生的不同经验观念如何影响手术结果尚不清楚。
ACS-NSQIP HPB-Collaborative 外科医生的自我报告经验参数与 2014-2016 年 ACS-NSQIP 临床数据合并。通过单变量和多变量分析研究了各种经验参数与结果的关联。层次回归评估了外科医生的表现。
111/151 位 HPB-Collaborative 外科医生提供了回复（73.5%）。与其他 532 位在 ACS-NSQIP 上进行胰腺切除术的外科医生相比，HPB-Collaborative 外科医生进行了 7692/16239 例全胰腺切除术（47.3%），严重发病率、胰腺瘘、再次手术、住院时间和再入院率的结果得到改善。回复者的中位年龄为 49 岁，92.8%接受过专科培训。中位职业和年度胰腺切除术量分别为 400 例和 35 例，中位年度机构切除量为 100 例。在未调整的分析中，经验的几个方面与研究的结果相关，特别是对于胰十二指肠切除术；然而，在多变量调整后，没有任何因素仍然具有统计学意义。外科医生的表现显示，胰十二指肠切除术和胰体尾切除术的表现具有相当大的一致性。
当代数据表明，对于在高质量环境下操作的外科医生，临床结果在很大程度上独立于经验指标。
