From the Department of Surgery, Hospital General Universitario Dr Balmis, Alicante, Spain (Ramia, Alcázar-López, Villodre-Tudela, Rubio-García).
ISABIAL, Alicante, Spain (Ramia, Alcázar-López, Villodre-Tudela, Rubio-García).
J Am Coll Surg. 2024 Sep 1;239(3):288-297. doi: 10.1097/XCS.0000000000001086. Epub 2024 Aug 15.
Improving the quality of care is a priority for health systems to obtain better care and reduce costs. One of the tools for measuring quality is benchmarking (BM). We presented a 1-country prospective study of distal pancreatectomies (DPs) and determined BM.
Prospective, multicenter, observational snapshot study of DP carried out at Spanish hepatopancreatobiliary centers for a year (February 1, 2022, to January 31, 2023). Hepatopancreatobiliary centers were defined as high volume if they performed more than 10 DPs per year. Inclusion criteria include any scheduled DP for any diagnosis and age older than 18 years. The low-risk group was defined following the criteria given by Durin and colleagues and major complications as Clavien-Dindo ≥III.
A total of 313 patients from 42 centers and 46.6% from high-volume centers were included. Median DP by center was 7 (interquartile range 5 to 10), median age was 65 years (interquartile range 55 to 74), and 53.4% were female. The surgical approach was minimally invasive in 69.3%. Major complications were 21.1%. Postoperative pancreatic fistula grade B/C rate was 20.1%, and 90-day mortality was 1.6%. One hundred forty-three patients were in low-risk group (43.8%). Compared with previous BM data, an increasing MIS rate and fewer hospital stay were obtained.
We present the first determination of DP-BM in a prospective series, obtaining similar results to the previous ones, but our BM values include a shorter hospital stay and a higher percentage of minimally invasive surgery probably related to Enhanced Recovery after Surgery protocols and prospective data collection. BM is a multiparameter valuable tool for reporting outcomes, comparing centers, and identifying the points to improve surgical care.
提高医疗质量是卫生系统的优先事项，以获得更好的护理和降低成本。衡量质量的工具之一是基准测试（BM）。我们进行了一项为期一年的西班牙肝胆胰中心开展的远端胰腺切除术（DP）的单国前瞻性研究，并确定了 BM。
这是一项 DP 的前瞻性、多中心、观察性快照研究，在西班牙肝胆胰中心进行了一年（2022 年 2 月 1 日至 2023 年 1 月 31 日）。如果肝胆胰中心每年进行超过 10 例 DP，则将其定义为高容量中心。纳入标准包括任何因任何诊断和年龄大于 18 岁而计划进行的 DP。低危组根据 Durin 等人的标准和 Clavien-Dindo≥III 级的主要并发症来定义。
共有 42 个中心的 313 名患者和 46.6%来自高容量中心被纳入。中心中位数 DP 为 7（四分位距 5 至 10），中位年龄为 65 岁（四分位距 55 至 74），53.4%为女性。微创入路占 69.3%。主要并发症为 21.1%。术后胰瘘 B/C 级发生率为 20.1%，90 天死亡率为 1.6%。143 例患者为低危组（43.8%）。与以前的 BM 数据相比，获得了微创率的增加和住院时间的减少。
我们首次在一项前瞻性系列中确定了 DP-BM，结果与以前的结果相似，但我们的 BM 值包括较短的住院时间和更高比例的微创手术，这可能与术后快速康复方案和前瞻性数据收集有关。BM 是报告结果、比较中心和确定提高手术护理质量的切入点的多参数有价值的工具。
