荷兰胰腺癌研究组强制审计头6年期间的胰腺手术结果

Outcome of Pancreatic Surgery During the First 6 Years of a Mandatory Audit Within the Dutch Pancreatic Cancer Group.

作者信息

Suurmeijer J Annelie, Henry Anne Claire, Bonsing Bert A, Bosscha Koop, van Dam Ronald M, van Eijck Casper H, Gerhards Michael F, van der Harst Erwin, de Hingh Ignace H, Intven Martijn P, Kazemier Geert, Wilmink Johanna W, Lips Daan J, Wit Fennie, de Meijer Vincent E, Molenaar I Quintus, Patijn Gijs A, van der Schelling George P, Stommel Martijn W J, Busch Olivier R, Groot Koerkamp Bas, van Santvoort Hjalmar C, Besselink Marc G

机构信息

Amsterdam UMC, Department of Surgery, University of Amsterdam, Amsterdam, the Netherlands.

Cancer Center Amsterdam, Amsterdam, the Netherlands.

出版信息

Ann Surg. 2023 Aug 1;278(2):260-266. doi: 10.1097/SLA.0000000000005628. Epub 2022 Jul 22.

DOI:10.1097/SLA.0000000000005628

PMID:35866656

Abstract

OBJECTIVE

To describe outcome after pancreatic surgery in the first 6 years of a mandatory nationwide audit.

BACKGROUND

Within the Dutch Pancreatic Cancer Group, efforts have been made to improve outcome after pancreatic surgery. These include collaborative projects, clinical auditing, and implementation of an algorithm for early recognition and management of postoperative complications. However, nationwide changes in outcome over time have not yet been described.

METHODS

This nationwide cohort study included consecutive patients after pancreatoduodenectomy (PD) and distal pancreatectomy from the mandatory Dutch Pancreatic Cancer Audit (January 2014-December 2019). Patient, tumor, and treatment characteristics were compared between 3 time periods (2014-2015, 2016-2017, and 2018-2019). Short-term surgical outcome was investigated using multilevel multivariable logistic regression analyses. Primary endpoints were failure to rescue (FTR) and in-hospital mortality.

RESULTS

Overall, 5345 patients were included, of whom 4227 after PD and 1118 after distal pancreatectomy. After PD, FTR improved from 13% to 7.4% [odds ratio (OR) 0.64, 95% confidence interval (CI) 0.50-0.80, P <0.001] and in-hospital mortality decreased from 4.1% to 2.4% (OR 0.68, 95% CI 0.54-0.86, P =0.001), despite operating on more patients with age >75 years (18%-22%, P =0.006), American Society of Anesthesiologists score ≥3 (19%-31%, P <0.001) and Charlson comorbidity score ≥2 (24%-34%, P <0.001). The rates of textbook outcome (57%-55%, P =0.283) and major complications remained stable (31%-33%, P =0.207), whereas complication-related intensive care admission decreased (13%-9%, P =0.002). After distal pancreatectomy, improvements in FTR from 8.8% to 5.9% (OR 0.65, 95% CI 0.30-1.37, P =0.253) and in-hospital mortality from 1.6% to 1.3% (OR 0.88, 95% CI 0.45-1.72, P =0.711) were not statistically significant.

CONCLUSIONS

During the first 6 years of a nationwide audit, in-hospital mortality and FTR after PD improved despite operating on more high-risk patients. Several collaborative efforts may have contributed to these improvements.

摘要

目的

描述在全国范围内强制审计的头6年中胰腺手术后的结果。

背景

在荷兰胰腺癌研究小组内，已努力改善胰腺手术后的结果。这些措施包括合作项目、临床审计以及实施术后并发症早期识别和管理算法。然而，尚未描述随时间推移全国范围内结果的变化情况。

方法

这项全国性队列研究纳入了荷兰胰腺癌强制审计（2014年1月至2019年12月）中接受胰十二指肠切除术（PD）和远端胰腺切除术后的连续患者。比较了3个时间段（2014 - 2015年、2016 - 2017年和2018 - 2019年）患者、肿瘤和治疗特征。使用多水平多变量逻辑回归分析研究短期手术结果。主要终点是救援失败（FTR）和住院死亡率。

结果

总体而言，共纳入5345例患者，其中4227例接受PD，1118例接受远端胰腺切除术。PD术后，FTR从13%改善至7.4%[比值比（OR）0.64，95%置信区间（CI）0.50 - 0.80，P <0.001]，住院死亡率从4.1%降至2.4%（OR 0.68，95% CI 0.54 - 0.86，P =0.001），尽管接受手术的75岁以上患者更多（18% - 22%，P =0.006）、美国麻醉医师协会评分≥3分的患者更多（19% - 31%，P <0.001）以及Charlson合并症评分≥2分的患者更多（24% - 34%，P <0.001）。教科书式结果的发生率（57% - 55%，P =0.283）和主要并发症发生率保持稳定（31% - 33%，P =0.207），而与并发症相关的重症监护病房入院率下降（13% - 9%，P =0.002）。远端胰腺切除术后，FTR从8.8%改善至5.9%（OR 0.65，95% CI 0.30 - 1.37，P =0.253）以及住院死亡率从1.6%降至1.3%（OR 0.88，95% CI 0.45 - 1.72，P =0.711），差异无统计学意义。