胰十二指肠切除术后并发症对死亡率、器官衰竭、住院时间和再入院的影响：全国性审计分析。

Impact of Complications After Pancreatoduodenectomy on Mortality, Organ Failure, Hospital Stay, and Readmission: Analysis of a Nationwide Audit.

机构信息

Department of Surgery, Regional Academic Cancer Centre Utrecht, University Medical Centre Utrecht and St Antonius Hospital Nieuwegein, Utrecht, The Netherlands.

Department of Surgery, University Medical Centre Groningen, University of Groningen, Groningen, The Netherlands.

出版信息

Ann Surg. 2022 Jan 1;275(1):e222-e228. doi: 10.1097/SLA.0000000000003835.

DOI:10.1097/SLA.0000000000003835

PMID:32502075

Abstract

OBJECTIVE

To quantify the impact of individual complications on mortality, organ failure, hospital stay, and readmission after pancreatoduodenectomy.

SUMMARY OF BACKGROUND DATA

An initial complication may provoke a sequence of adverse events potentially leading to mortality after pancreatoduodenectomy. This study was conducted to aid prioritization of quality improvement initiatives.

METHODS

Data from consecutive patients undergoing pancreatoduodenectomy (2014-2017) were extracted from the Dutch Pancreatic Cancer Audit. Population attributable fractions (PAF) were calculated for the association of each complication (ie, postoperative pancreatic fistula, postpancreatectomy hemorrhage, bile leakage, delayed gastric emptying, wound infection, and pneumonia) with each unfavorable outcome [ie, in-hospital mortality, organ failure, prolonged hospital stay (>75th percentile), and unplanned readmission), whereas adjusting for confounders and other complications. The PAF represents the proportion of an outcome that could be prevented if a complication would be eliminated completely.

RESULTS

Overall, 2620 patients were analyzed. In-hospital mortality occurred in 95 patients (3.6%), organ failure in 198 patients (7.6%), and readmission in 427 patients (16.2%). Postoperative pancreatic fistula and postpancreatectomy hemorrhage had the greatest independent impact on mortality [PAF 25.7% (95% CI 13.4-37.9) and 32.8% (21.9-43.8), respectively] and organ failure [PAF 21.8% (95% CI 12.9-30.6) and 22.1% (15.0-29.1), respectively]. Delayed gastric emptying had the greatest independent impact on prolonged hospital stay [PAF 27.6% (95% CI 23.5-31.8)]. The impact of individual complications on unplanned readmission was smaller than 11%.

CONCLUSION

Interventions focusing on postoperative pancreatic fistula and postpancreatectomy hemorrhage may have the greatest impact on in-hospital mortality and organ failure. To prevent prolonged hospital stay, initiatives should in addition focus on delayed gastric emptying.

摘要

目的

量化单个并发症对胰十二指肠切除术后死亡率、器官衰竭、住院时间和再入院的影响。

背景资料概要

初始并发症可能引发一系列不良事件，从而导致胰十二指肠切除术后死亡。进行这项研究是为了帮助确定质量改进计划的优先级。

方法

从荷兰胰腺肿瘤审计数据库中提取 2014 年至 2017 年间连续接受胰十二指肠切除术的患者的数据。计算每个并发症（即术后胰瘘、胰十二指肠切除术后出血、胆漏、胃排空延迟、伤口感染和肺炎）与每个不利结局（即院内死亡率、器官衰竭、住院时间延长（超过第 75 个百分位）和计划外再入院）的关联的人群归因分数（PAF），同时调整混杂因素和其他并发症。PAF 代表如果完全消除并发症，可预防的结局比例。

结果

共分析了 2620 例患者。95 例（3.6%）发生院内死亡，198 例（7.6%）发生器官衰竭，427 例（16.2%）发生再入院。术后胰瘘和胰十二指肠切除术后出血对死亡率有最大的独立影响[PAF 分别为 25.7%（95%CI 13.4-37.9）和 32.8%（21.9-43.8）]和器官衰竭[PAF 分别为 21.8%（95%CI 12.9-30.6）和 22.1%（15.0-29.1）]。胃排空延迟对住院时间延长的独立影响最大[PAF 为 27.6%（95%CI 23.5-31.8）]。单个并发症对计划外再入院的影响小于 11%。