Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
Department of Surgery, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
J Surg Res. 2020 Jun;250:80-87. doi: 10.1016/j.jss.2019.12.041. Epub 2020 Feb 2.
Patients undergoing pancreaticoduodenectomy are at risk for a variety of adverse postoperative events, including generic complications such as surgical site infection (SSI) and procedure-specific complications such as postoperative pancreatic fistula (POPF) and delayed gastric emptying (DGE). Knowing which complications have the greatest effect on these patients can help to maximize the value of quality improvement resources. This study aims to quantify the effect of specific postoperative complications on clinical outcomes and resource utilization after pancreaticoduodenectomy.
Patients undergoing pancreaticoduodenectomy between January 2014 and December 2016, who were included in the pancreatectomy-targeted American College of Surgeons National Surgical Quality Improvement Program, were assessed for the development of specific postoperative complications, along with the contributions of these complications toward subsequent clinical outcome and resource utilization. The main outcomes were 30-d end-organ dysfunction, mortality, prolonged hospitalization, nonrounding discharge status, and hospital readmission. Risk-adjusted population attributable fractions were estimated for each complication-outcome pair, with the population attributable fraction representing the anticipated percentage reduction in the outcome where the complication was able to be completely prevented.
About 10,922 patients undergoing pancreaticoduodenectomy were included for analysis. The most common postoperative complications were DGE (17.3%), POPF (10.1%), incisional SSI (10.0%), and organ/space SSI (6.2%). POPF and DGE were the only complications that demonstrated sizable effects for all clinical and resource utilization outcomes studied. Other complications had sizable effects for only a few of the outcomes or had small effects for all the outcomes.
Quality initiatives seeking to minimize the burden imposed by postpancreaticoduodenectomy morbidity should focus on POPF and DGE rather than generic complications.
接受胰十二指肠切除术的患者存在多种不良术后事件的风险，包括一般并发症，如手术部位感染（SSI）和特定手术并发症，如术后胰瘘（POPF）和胃排空延迟（DGE）。了解哪些并发症对这些患者的影响最大有助于最大限度地利用质量改进资源。本研究旨在量化特定术后并发症对胰十二指肠切除术后临床结果和资源利用的影响。
评估了 2014 年 1 月至 2016 年 12 月期间接受胰十二指肠切除术并被纳入胰腺切除术靶向美国外科医师学会国家手术质量改进计划的患者是否发生特定的术后并发症，以及这些并发症对随后的临床结果和资源利用的影响。主要结局为 30 天终末器官功能障碍、死亡率、住院时间延长、非标准出院状态和医院再入院。对每个并发症-结局组合进行了风险调整的人群归因分数估计，人群归因分数代表如果完全预防该并发症，预期结局的百分比降低。
约有 10922 例接受胰十二指肠切除术的患者被纳入分析。最常见的术后并发症是 DGE（17.3%）、POPF（10.1%）、切口 SSI（10.0%）和器官/空间 SSI（6.2%）。POPF 和 DGE 是唯一对所有研究的临床和资源利用结局都有显著影响的并发症。其他并发症仅对几个结局有显著影响，或对所有结局都有较小的影响。
旨在减轻胰十二指肠切除术后发病率负担的质量改进计划应侧重于 POPF 和 DGE，而不是一般并发症。
