Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy.
Department of Gastroenterology, Valduce Hospital, Como, Italy.
Gastrointest Endosc. 2022 Jun;95(6):1158-1172. doi: 10.1016/j.gie.2021.12.006. Epub 2021 Dec 18.
There is increasing interest in expanding the use of lumen-apposing metal stents (LAMSs) in patients with pancreatic fluid collections (PFCs). The aim of this study was to determine whether there is a hospital volume threshold for which patient outcomes could be optimized.
Data from a large multicenter series of patients with PFCs treated with LAMSs were retrieved. Rate of adverse events (AEs) was the primary outcome. Multivariable models with restricted cubic splines were used to identify a hospital volume threshold by plotting hospital volume against the log odds ratio (OR) of AE rate. Propensity score matching was applied to obtain 2 well-balanced groups according to hospital volume, and univariate/multivariate logistic regression analysis was performed to identify significant predictors of AEs.
Overall, 516 patients were included. Increasing hospital volume was associated with a reduced AE rate (P = .03), and the likelihood of experiencing an AE declined as hospital volume increased up to 15 cases. After propensity score matching, 175 patients in the high-volume (>15 cases) and 132 in the low-volume hospital group were compared. Overall, 41 AEs were observed (13.3%), of which 14 (8%) and 27 (20.4%) occurred at high-volume and low-volume centers, respectively (P = .001). Severe and fatal events were observed more frequently in low-volume centers (6% vs 1.7% and 2.2% vs 0%, respectively; P = .05). In multivariate analysis, main pancreatic duct injury (OR, 2.62; 95% confidence interval [CI], 1.26-4.67; P = .02), presence of abnormal vessels (OR, 2.93; 95% CI, 1.41-5.02; P = .006), and institutional experience (OR, 2.95; 95% CI, 1.48-5.90; P = .002) were significant predictors of AEs.
With 15 procedures representing the minimum number of cases associated with the lowest risk for postprocedural AEs, hospital volume is associated with improved outcomes. (Clinical trial registration number: NCT03903523.).
人们对扩大使用腔内置入式金属支架（LAMS）治疗胰腺液体积聚（PFC）的兴趣日益增加。本研究的目的是确定是否存在一个医院工作量阈值，使患者的预后可以得到优化。
检索了一项大型多中心 LAMS 治疗 PFC 患者系列研究的数据。不良事件（AE）发生率为主要结局。采用限制立方样条的多变量模型，通过绘制医院工作量与 AE 发生率的对数比值（OR）来确定医院工作量阈值。应用倾向评分匹配根据医院工作量获得 2 个均衡良好的组，然后进行单变量/多变量逻辑回归分析，以确定 AE 的显著预测因素。
共有 516 例患者纳入研究。随着医院工作量的增加，AE 发生率降低（P=.03），并且随着医院工作量增加，发生 AE 的可能性降低，最高可达 15 例。在进行倾向评分匹配后，比较了高工作量（>15 例）组的 175 例患者和低工作量医院组的 132 例患者。总体而言，观察到 41 例 AE（13.3%），其中分别有 14 例（8%）和 27 例（20.4%）发生在高工作量和低工作量中心（P=.001）。低工作量中心更常发生严重和致命事件（分别为 6%比 1.7%和 2.2%比 0%；P=.05）。多变量分析显示，主胰管损伤（OR，2.62；95%置信区间[CI]，1.26-4.67；P=.02）、存在异常血管（OR，2.93；95%CI，1.41-5.02；P=.006）和机构经验（OR，2.95；95%CI，1.48-5.90；P=.002）是 AE 的显著预测因素。
在 15 例手术中，代表了与术后 AE 风险最低相关的最低例数，医院工作量与改善预后相关。（临床试验注册号：NCT03903523.）
