Br J Surg. 2024 Jan 3;111(1). doi: 10.1093/bjs/znad330.
Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.
This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.
A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 per cent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 per cent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 per cent; however, it was 41 per cent in low-to-middle- compared with 19 per cent in very high-HDI countries.
Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761).
胰腺手术仍然与高发病率相关。尽管随着专业化的发展，术后死亡率似乎有所改善，但文献中的结果反映了高度专业化中心的活动。本研究旨在评估全球范围内胰腺手术后的结果。
这是一项国际性、前瞻性、多中心、横截面快照研究，于 2021 年在三个月的时间内对全球范围内接受胰腺手术的连续患者进行了研究。主要结局是手术后 90 天内的死亡率。多变量逻辑回归用于探索与人类发展指数（HDI）和其他参数的关系。
共分析了来自 67 个国家的 4223 名患者。68.7%（2901/4223）的患者出现任何严重程度的并发症。高、极高 HDI 国家的主要并发症发生率（Clavien-Dindo 分级至少 IIIa 级）分别为 24%、18%和 27%，死亡率分别为 10%、5%和 5%。总体术后 90 天死亡率为 5.4%（4223 例中有 229 例），但在中低 HDI 国家显著较高（校正比值比 2.88，95%置信区间 1.80 至 4.48）。总体抢救失败率为 21%；然而，在中低 HDI 国家为 41%，而在极高 HDI 国家为 19%。
中低 HDI 国家的死亡率过高可能归因于未能抢救严重并发症患者。作者呼吁国际和地区胰腺外科协会采取协作应对措施，解决与术后并发症死亡相关的管理问题，以解决胰腺手术后结果的全球差异（NCT04652271；ISRCTN95140761）。
