肝切除术后预防性引流的医院差异。

Hospital variation in use of prophylactic drains following hepatectomy.

机构信息

American College of Surgeons, Chicago, IL, USA; Surgical Outcomes and Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.

American College of Surgeons, Chicago, IL, USA; VA Greater Los Angeles Healthcare System, Los Angeles, CA; Department of Surgery, David Geffen School of Medicine at the University of California, Los Angeles, CA, USA.

出版信息

HPB (Oxford). 2020 Oct;22(10):1471-1479. doi: 10.1016/j.hpb.2020.02.006. Epub 2020 Mar 12.

DOI:10.1016/j.hpb.2020.02.006

PMID:32173175

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC8385641/

Abstract

BACKGROUND

Prophylactic drainage following hepatectomy is frequently performed despite evidence that drainage is unnecessary. It is unknown to what extent drain use is influenced by hospital practice patterns. The objectives of this study were to identify factors associated with the use of prophylactic drains following hepatectomy and assess hospital variation in drain use.

METHODS

Retrospective cohort study of patients following hepatectomy without concomitant bowel resection or biliary reconstruction from the ACS NSQIP Hepatectomy Targeted Dataset. Factors associated with the use of prophylactic drains were identified using multivariable logistic regression and hospital-level variation in drain use was assessed.

RESULTS

Analysis included 10,530 patients at 130 hospitals. Overall, 42.3% of patients had a prophylactic drain placed following hepatectomy. Patients were more likely to receive prophylactic drains if they were ≥65 years old (adjusted odds ratio [aOR]: 1.34, 95%CI: 1.16-1.56), underwent major hepatectomy (aOR: 1.42, 95%CI 1.15-1.74), or had an open resection (aOR 1.94, 95%CI 1.49-2.53). There was notable hospital variability in drain use (range: 0%-100% of patients), and 77.5% of measured variation was at the hospital level.

CONCLUSION

Prophylactic drains are commonly placed in both major and minor hepatectomy. Hospital-specific patterns appear to be a major driver and represent a target for improvement.

摘要

背景

尽管有证据表明引流是不必要的，但肝切除术后预防性引流仍经常进行。目前尚不清楚引流的使用在多大程度上受到医院实践模式的影响。本研究的目的是确定与肝切除术后预防性引流使用相关的因素，并评估医院在引流使用方面的差异。

方法

回顾性队列研究，纳入了来自 ACS NSQIP 肝切除术靶向数据集的无合并肠切除或胆道重建的肝切除术患者。使用多变量逻辑回归确定与预防性引流使用相关的因素，并评估医院间引流使用的差异。

结果

分析纳入了 130 家医院的 10530 名患者。总体而言，42.3%的肝切除术后患者放置了预防性引流管。如果患者年龄≥65 岁（调整优势比[aOR]：1.34，95%CI：1.16-1.56）、接受了大肝切除术（aOR：1.42，95%CI 1.15-1.74）或接受了开放性切除术（aOR：1.94，95%CI：1.49-2.53），则更有可能放置预防性引流管。引流使用存在显著的医院间差异（范围：0%-100%的患者），且 77.5%的差异可归因于医院水平。