University of Pittsburgh Medical Center, Pittsburgh, PA.
Indiana University School of Medicine, Indianapolis, IN.
Ann Surg. 2021 Oct 1;274(4):e355-e363. doi: 10.1097/SLA.0000000000003628.
Our aims were to assess North American trends in the management of patients undergoing pancreatoduodenectomy (PD) and distal pancreatectomy (DP), and to quantify the delivery of optimal pancreatic surgery.
Morbidity after pancreatectomy remains unacceptably high. Recent literature suggests that composite measures may more accurately define surgical quality.
The 2013 to 2017 American College of Surgeons National Surgical Quality Improvement Program Participant Use Files were queried to identify patients undergoing PD (N = 16,222) and DP (N = 7946). Patient, process, procedure, and 30-day postoperative outcome variables were analyzed over time. Optimal pancreatic surgery was defined as the absence of postoperative mortality, serious morbidity, percutaneous drainage, and reoperation while achieving a length of stay equal to or less than the 75th percentile (12 days for PD and 7 days for DP) with no readmissions. Risk-adjusted time-trend analyses were performed using logistic regression, and the threshold for statistical significance was P ≤ 0.05.
The use of minimally invasive PD did not change over time, but robotic PD increased (2.5 to 4.2%; P < 0.001) and laparoscopic PD decreased (5.8% to 4.3%; P < 0.02). Operative times decreased (P < 0.05) and fewer transfusions were administered (P < 0.001). The percentage of patients with a drain fluid amylase checked on postoperative day 1 increased (P < 0.001), and a greater percentage of surgical drains were removed by postoperative day 3 (P < 0.001). Overall morbidity (P < 0.02), mortality (P < 0.05), and postoperative length of stay (P = 0.002) decreased. Finally, the rate of optimal pancreatic surgery increased for PD (53.7% to 56.9%; P < 0.01) and DP (53.3% to 58.5%; P < 0.001), and alspo for patients with pancreatic cancer (P < 0.01).
From 2013 to 2017, pre, intra, and perioperative pancreatectomy processes have evolved, and multiple postoperative outcomes have improved. Thus, in 4 years, optimal pancreatic surgery in North America has increased by 3% to 5%.
评估北美胰十二指肠切除术（PD）和胰体尾切除术（DP）患者管理的趋势，并量化最佳胰腺手术的实施情况。
胰腺手术后的发病率仍然高得不可接受。最近的文献表明，综合指标可能更准确地定义手术质量。
2013 年至 2017 年，美国外科医师学院国家手术质量改进计划参与者使用文件被查询，以确定接受 PD（N=16222）和 DP（N=7946）的患者。随着时间的推移，分析患者、过程、程序和 30 天术后结果变量。最佳胰腺手术的定义为术后无死亡、严重并发症、经皮引流和再次手术，同时达到或低于第 75 百分位的住院时间（PD 为 12 天，DP 为 7 天），且无再入院。使用逻辑回归进行风险调整的时间趋势分析，统计显著性阈值为 P≤0.05。
微创 PD 的使用率没有随时间变化，但机器人 PD 增加（2.5%至 4.2%；P＜0.001），而腹腔镜 PD 减少（5.8%至 4.3%；P＜0.02）。手术时间缩短（P＜0.05），输血减少（P＜0.001）。术后第 1 天检查引流液淀粉酶的患者比例增加（P＜0.001），术后第 3 天更多的外科引流管被拔除（P＜0.001）。总体发病率（P＜0.02）、死亡率（P＜0.05）和术后住院时间（P=0.002）降低。最后，PD（53.7%至 56.9%；P＜0.01）和 DP（53.3%至 58.5%；P＜0.001）以及胰腺癌患者的最佳胰腺手术率也有所提高（P＜0.01）。
从 2013 年到 2017 年，术前、术中和围手术期的胰腺切除术过程发生了演变，多项术后结果得到了改善。因此，在 4 年内，北美最佳胰腺手术的比例增加了 3%至 5%。
