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胰腺切除术后的理想结果:对协调复合结果衡量的跨大西洋评估
Simone Augustinus1,2, Tara M Mackay1,2, Bodil Andersson3
1Department of Surgery, Amsterdam UMC, Location University of Amsterdam, Amsterdam, The Netherlands.
Annals of surgery
|July 21, 2023
概括
在北美和欧洲定义并评估了胰腺二切除术的新"理想结果"措施. 这个指标有助于审计和比较手术结果,指导胰腺手术结果的改善.
科学领域:
- 手术成果研究的研究结果.
- 多中心对比疗效研究多中心对比疗效研究
- 在瘤学领域的医疗服务研究.
背景情况:
- 评估胰腺切除术的结果需要一个全面的评估超出单个参数.
- 之前已经开发了"教科书结果"和"最佳胰腺手术"等复合措施.
- 理想结果 (IO) 协调了这些概念,以便进行更全面的评估.
研究的目的:
- 定义和评估胰腺二切除术的新型"理想结果" (IO) 复合措施.
- 评估北美,德国,荷兰和瑞典的国家注册处的IO率.
- 为了确定与胰腺切除术后实现IO相关的因素.
主要方法:
- 一项跨大西洋的回顾性研究 (2018-2020年) 分析了来自北美和欧洲注册的胰腺二切除术数据.
- 通过共识,理想结果被定义为没有住院死亡率,严重并发症,胰腺,重新手术,长时间住院和再入院.
- 结果被评估使用统计措施,如相对最大差异 (RLD) 和绝对最大差异 (ALD),以及多变量回归.
主要成果:
- 总体而言,在21036名患者中,54%的患者在胰腺二切除术后实现了理想结局 (IO).
- IO率在不同地区之间略有差异 (52-55%),但个别组件,如严重并发症和术后胰腺瘤,差异很大 (分别为12%和10%的ALD).
- 与改善IO相关的因素包括患者人口统计学,并发症,手术方法 (例如,血管切除的缺乏),以及胰腺腺癌,新辅助化疗和国家.
结论:
- 新开发的"理想结果"是一个有价值的综合措施,用于审计和比较胰腺切除术结果.
- 观察到的IO组件的变化突出了针对性干预的机会.
- 这一指标可以指导全球合作努力,以提高胰腺手术的结果.
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