Department of General, Visceral, Transplant, Vascular and Pediatric Surgery at Würzburg University Hospital, Würzburg, Germany; Department of Visceral, Transplant, Thoracic and Vascular Surgery at Leipzig University Hospital, Leipzig, Germany.
Marienkrankenhaus, Hamburg, Germany.
Eur J Surg Oncol. 2022 Apr;48(4):924-932. doi: 10.1016/j.ejso.2021.12.006. Epub 2021 Dec 5.
The German Cancer Society (DKG) board certifies hospitals in treating esophageal, gastric, liver and pancreatic cancer among others. There has been no systematic verification of the number of major surgical resections set by DKG certification with regards to in-house mortality and failure to rescue (FtR).
This is a retrospective analysis of anonymized nationwide hospital billing data (DRG data, 2009-2017). Inclusion criteria were based on the annual surgical minimum caseload (SMC) in accordance with DKG certification.
171,429 datasets were identified, including 31,140 esophageal, 54,155 gastric, 57,343 pancreatic and 28,791 liver resections. In-house mortality ranged from 6.2% for gastric resections to 8.1% for pancreatic resections. Differences in in-house mortality between hospitals which fulfilled SMC on average and those which did not fulfill SMC on average were 40.8% (5.3% vs 8.2%) for esophageal, 32.3% (4.8% vs 6.8%) for gastric and 45.7% (6.1% vs 9.8%) for pancreatic resections, while it was 8.2% higher in SMC-hospitals (7.6% vs 7.0%) for liver resections. Complication occurrence rates for esophageal, gastric and pancreatic resections were similar in SMC- and non-SMC-hospitals while FtR in hospitals fulfilling SMC was significantly lower. Data for liver resections demonstrated the same trends only in a sub-analysis of complex procedures.
This study demonstrates an association between caseload threshold defined by DKG and lower mortality in esophageal, gastric, pancreatic and complex liver surgery. In these resections, FtR was reduced if SMC was fulfilled.
德国癌症协会（DKG）董事会认证医院治疗食管癌、胃癌、肝癌和胰腺癌等疾病。目前尚未对 DKG 认证的主要手术切除数量与院内死亡率和抢救失败率（FtR）进行系统验证。
这是一项对匿名全国医院计费数据（DRG 数据，2009-2017 年）进行的回顾性分析。纳入标准基于与 DKG 认证相符的年度手术最低病例数（SMC）。
共确定了 171429 个数据集，包括 31140 例食管切除术、54155 例胃切除术、57343 例胰切除术和 28791 例肝切除术。院内死亡率范围从胃切除术的 6.2%到胰切除术的 8.1%。符合 SMC 的医院与不符合 SMC 的医院之间的院内死亡率差异分别为食管切除术 40.8%（5.3%比 8.2%）、胃切除术 32.3%（4.8%比 6.8%）和胰切除术 45.7%（6.1%比 9.8%），而 SMC 医院的肝切除术死亡率高 8.2%（7.6%比 7.0%）。食管、胃和胰切除术的并发症发生率在 SMC 和非 SMC 医院相似，而符合 SMC 的医院的抢救失败率明显较低。只有在对复杂手术的亚分析中，肝切除术的数据才显示出相同的趋势。
本研究表明，DKG 定义的病例量阈值与食管癌、胃癌、胰腺癌和复杂肝手术的死亡率降低相关。在这些切除术，如果符合 SMC，则抢救失败率降低。
