Jogerst Kristen M, Chang Yu-Hui H, Etzioni David A, Mathur Amit K, Habermann Elizabeth B, Wasif Nabil
Department of Surgery, Mayo Clinic Arizona, 5777 East Mayo Blvd, Phoenix, AZ, 85054, USA.
Department of Biostatistics, Mayo Clinic Arizona, 13400 East Shea Blvd, Scottsdale, AZ, 85259, USA; Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, 200 First St. SW, Rochester, MN, 55905, USA.
Am J Surg. 2022 Feb;223(2):318-324. doi: 10.1016/j.amjsurg.2021.03.030. Epub 2021 Mar 19.
The volume-mortality association led to regionalization recommendations for pancreatic surgery. Mortality following pancreatectomy has declined, but case-volume thresholds remain unchanged.
Patients undergoing pancreatectomy from 2004 to 2013 were identified in the National Cancer Database (NCDB). Hospitals were divided into low (LV), medium (MV), and high-volume (HV) strata using 30-day mortality quartiles and logistic regression with cubic splines. Adjusted absolute difference and odds of 30-day mortality between strata were calculated.
Annual volumes for LV, MV, and HV were <4, 4-18 and > 18 cases using quartiles and <6, 6-18 and > 18 using cubic splines. Absolute 30-day mortality trended downwards, with differential improvements for MV and LV. Benchmark 30-day mortality for hospitals with >18 cases was 2.8%. For this benchmark, the case-volume threshold decreased from 31 in 2004 to 6 in 2013.
Differential improvement in 30-day mortality at LV and MV hospitals led to similar 30-day mortality odds at MV and HV hospitals by 2013.
手术量与死亡率的关联促使了胰腺手术区域化建议的出台。胰腺切除术后的死亡率有所下降，但手术量阈值仍未改变。
在国家癌症数据库（NCDB）中识别出2004年至2013年期间接受胰腺切除术的患者。利用30天死亡率四分位数和三次样条逻辑回归将医院分为低手术量（LV）、中等手术量（MV）和高手术量（HV）组。计算各分组之间30天死亡率的调整后绝对差值和比值。
使用四分位数时，LV、MV和HV的年手术量分别为<4例、4 - 18例和>18例；使用三次样条时，分别为<6例、6 - 18例和>18例。30天绝对死亡率呈下降趋势，MV和LV有不同程度的改善。手术量>18例的医院的基准30天死亡率为2.8%。以此为基准，手术量阈值从2004年的31例降至2013年的6例。
LV和MV医院30天死亡率的不同程度改善导致到2013年MV和HV医院的30天死亡率比值相近。
