Department of Digestive Surgery and Transplantation, Lille University Hospital, Lille, France.
University of Lille, Lille, France.
Ann Surg. 2020 Nov;272(5):723-730. doi: 10.1097/SLA.0000000000004342.
We aimed to analyze the outcomes of interhospital transfer (IHT) patients after pancreatectomy, describe the characteristics of transferring hospitals, and determine the risk factors of transfer and mortality in IHT patients.
Implementation of the centralization process is complex and currently unrealized in France. Alternatively, centralization of patients with postoperative complications to high volume centers could reduce postoperative mortality (POM) and failure to rescue (FTR).
All patients undergoing pancreatectomy for cancer between 2012 and 2018 were included. Hospitals' and patients' characteristics were analyzed to determine predictive factors for transfer and FTR. POM was defined as death occurring during the hospital stay and FTR as POM rate among patients with major complications.
Overall, 19,938 patients who underwent pancreatectomy were included, 1164 (5.8%) of whom were transferred. IHT patients were mostly originated from low volume hospitals (60.3% vs 39.7%), from facilities without intensive care unit (46.9% vs 22.4%) or interventional radiology (22.8% vs 12.8%). Among IHT patients, 51% underwent reoperation before transfer and 34.9% experienced hemorrhage complications. The POM was 5.2% and varied significantly between transfer and nontransfer patients (13.3% vs 4.7%, P < 0.001). Patients who experienced major complications after pancreatectomy in low volume hospitals had greater odds of being transferred (Odds Ratio (OR) = 2.46, confidence intervals (CI)95%[1.734; 3.516], P < 0.001). Also, transfer (OR = 2.17, CI95%[1.814; 2.709], P < 0.001) and especially transfer after pancreatectomy in low volume centers (OR = 3.76, CI95%[2.83; 5.01], P < 0.001) were associated with increased FTR rates.
Transfers after pancreatectomy were associated with high rates of FTR, especially for patients undergoing surgery in low volume hospitals. Local expertise, resources, and volume of hospitals are mandatory to provide appropriate care after pancreatectomy.
分析胰腺切除术后院内转移（IHT）患者的结局，描述转入医院的特征，并确定 IHT 患者转移和死亡的危险因素。
集中化进程的实施在法国很复杂，目前尚未实现。或者，将术后并发症患者集中到高容量中心，可以降低术后死亡率（POM）和救援失败率（FTR）。
纳入 2012 年至 2018 年间接受胰腺切除术治疗癌症的所有患者。分析医院和患者的特征，以确定转移和 FTR 的预测因素。POM 定义为住院期间死亡，FTR 定义为有严重并发症患者的 POM 发生率。
共纳入 19938 例接受胰腺切除术的患者，其中 1164 例（5.8%）发生转移。IHT 患者主要来自低容量医院（60.3%比 39.7%），来自无重症监护病房（46.9%比 22.4%）或介入放射科（22.8%比 12.8%）的医院。在 IHT 患者中，51%在转移前接受了再次手术，34.9%出现出血并发症。POM 为 5.2%，在转移和非转移患者之间差异显著（13.3%比 4.7%，P<0.001）。在低容量医院接受胰腺切除术后发生严重并发症的患者更有可能转移（优势比（OR）=2.46，95%置信区间（CI）[1.734; 3.516]，P<0.001）。此外，转移（OR=2.17，95%CI[1.814; 2.709]，P<0.001），尤其是在低容量中心手术后转移（OR=3.76，95%CI[2.83; 5.01]，P<0.001）与 FTR 率增加相关。
胰腺切除术后的转移与 FTR 发生率较高相关，尤其是在低容量医院接受手术的患者。当地的专业知识、资源和医院的容量是提供胰腺切除术后适当治疗的必要条件。
