Nurminen Nelli, Järvinen Tommi, Robinson Eric, Zhou Nanruoyi, Salo Silja, Räsänen Jari, Kytö Ville, Ilonen Ilkka
Department of General Thoracic and Esophageal surgery, Heart and Lung Center, HUS Helsingin yliopistollisen sairaala, Helsinki, Finland.
Department of Thoracic Surgery, Icahn School of Medicine at Mount Sinai, New York, United States.
Endosc Int Open. 2024 Mar 18;12(3):E385-E393. doi: 10.1055/a-2265-8757. eCollection 2024 Mar.
Upper gastrointestinal endoscopy (EGD) is one of the most common diagnostic procedures done to examine the foregut, but it can also be used for therapeutic interventions. The main objectives of this study were to investigate trends in EGD utilization and mortality related to it in a national low-threshold healthcare system, assess perioperative safety, and identify and describe patient-reported malpractice claims from the national database. We retrospectively identified patients from the Finnish Patient Care Registry who underwent diagnostic or procedural EGD between 2010 and 2018. In addition, patient-reported claims for malpractice were analyzed from the National Patient Insurance Center (PIC) database. Patient survival data were gathered collectively from the National Death Registry from Statistics Finland. During the study period, 409,153 EGDs were performed in Finland for 298,082 patients, with an annual rate of 9.30 procedures per 1,000 inhabitants, with an annual increase of 2.6%. Thirty-day all-cause mortality was 1.70% and 90-day mortality was 3.84%. For every 1,000 patients treated, 0.23 malpractice claims were filed. The annual rate of EGD increased by 2.6% during the study, while the rate of interventional procedures remained constant. Also, while the 30-day mortality rate declined over the study period, it is an unsuitable quality metric for EGDs in comprehensive centers because a patient's underlying disease plays a larger role than the procedure in perioperative mortality. Finally, there were few malpractice claims, with self-evident causes prevailing.
上消化道内镜检查（EGD）是检查前肠最常用的诊断程序之一，但它也可用于治疗干预。本研究的主要目的是调查在全国低门槛医疗系统中EGD的使用趋势及其相关死亡率，评估围手术期安全性，并从国家数据库中识别和描述患者报告的医疗事故索赔。我们回顾性地从芬兰患者护理登记处确定了2010年至2018年间接受诊断性或程序性EGD的患者。此外，还从国家患者保险中心（PIC）数据库中分析了患者报告的医疗事故索赔。患者生存数据是从芬兰统计局的国家死亡登记处汇总收集的。在研究期间，芬兰对298,082名患者进行了409,153次EGD检查，年发生率为每1000名居民9.30次，年增长率为2.6%。30天全因死亡率为1.70%，90天死亡率为3.84%。每治疗1000名患者，就有0.23起医疗事故索赔。在研究期间，EGD的年发生率增加了2.6%，而介入性手术的发生率保持不变。此外，虽然在研究期间30天死亡率有所下降，但在综合中心，它不是评估EGD的合适质量指标，因为患者的基础疾病在围手术期死亡率中比手术本身起更大的作用。最后，医疗事故索赔很少，明显原因占主导。
