General Surgery Residency Program, Dwight D. Eisenhower Army Medical Center, Fort Eisenhower, GA, USA.
Reno School of Medicine, University of Nevada, Reno, NV, USA.
Am Surg. 2024 Jun;90(6):1412-1417. doi: 10.1177/00031348241241746. Epub 2024 Mar 21.
Pancreatic surgery is technically challenging, with mortality rates at high-volume centers ranging from 0% to 5%. An inverse relationship between surgeon volume and perioperative mortality has been reported suggesting that patients benefit from experienced surgeons at high-volume centers. There is little published on the volume of pancreatic surgeries performed in military treatment facilities (MTF) and there is no centralization policy regarding pancreatic surgery. This study evaluates pancreatic procedures at MTFs. We hypothesize that a small group of MTFs perform most pancreatic procedures, including more complex pancreatic surgeries.
This is a retrospective review of de-identified data from MHS Mart (M2) from 2014 to 2020. The database contains patient data from all Defense Health Agency treatment facilities. Variables collected include number and types of pancreatic procedures performed and patient demographics. The primary endpoint was the number and type of surgery for each MTF.
Twenty-six MTFs performed pancreatic surgeries from 2014 to 2020. There was a significant decrease in the number of cases from 2014 to 2020. Nine hospitals performed one surgery over eight years. The most common surgery was a distal pancreatectomy, followed by a pancreaticoduodenectomy. There was a decrease in the number of pancreaticoduodenectomies and distal pancreatectomies performed over this period.
Pancreatic surgery is being performed at few MTFs with a downward trajectory over time. Further studies would be needed to assess the impact on patient care regarding postoperative complications, barriers to timely patient care, and impact on readiness of military surgeons.
胰腺手术技术难度大，高容量中心的死亡率在 0%至 5%之间。有报道称，外科医生的手术量与围手术期死亡率呈反比关系，这表明患者从高容量中心经验丰富的外科医生中受益。关于军事治疗设施（MTF）中进行的胰腺手术量，发表的资料很少，而且关于胰腺手术没有集中化政策。本研究评估了 MTF 中的胰腺手术。我们假设一小部分 MTF 进行了大多数胰腺手术，包括更复杂的胰腺手术。
这是对 2014 年至 2020 年 MHS Mart（M2）中去识别数据的回顾性研究。该数据库包含来自所有国防卫生署治疗设施的患者数据。收集的变量包括进行的胰腺手术数量和类型以及患者人口统计学信息。主要终点是每个 MTF 的手术数量和类型。
26 家 MTF 在 2014 年至 2020 年间进行了胰腺手术。病例数量从 2014 年到 2020 年显著减少。九家医院在八年中只进行了一次手术。最常见的手术是胰尾部切除术，其次是胰十二指肠切除术。在此期间，胰十二指肠切除术和胰尾部切除术的数量有所减少。
胰腺手术仅在少数 MTF 进行，且随着时间的推移呈下降趋势。需要进一步研究以评估对术后并发症、及时治疗患者的障碍以及对军事外科医生准备情况的影响。
