不仅是病例,而且患者的选择是预测胰腺切除后的死亡率
Rene Mantke1,2, Barbara Seliger3, Shuji Ogino4,5,6,7
1From the Department of General Surgery, University Hospital Brandenburg, Brandenburg Medical School Theodor Fontane, Brandenburg, Germany.
概括
在高容量中心 (HVPC) 中集中胰腺手术可以降低住院死亡率. 然而,在HVPC中,更健康的患者群体也为这些改善结果做出了贡献,而不仅仅是外科专业知识.
科学领域:
- 手术结果研究研究.
- 医疗保健服务研究 医疗服务研究
- 在瘤学瘤学.
背景情况:
- 将胰腺手术集中到高容量中心 (HVPC) 是改善患者治疗结果的一种策略.
- 除了HVPC中的病例数量之外,影响住院死亡率的因素需要澄清.
研究的目的:
- 调查高容量胰腺中心 (HVPC) 对胰腺切除后住院死亡率的影响.
- 确定患者特征和并发症对HVPC和非HVPC之间结果差异的贡献程度.
主要方法:
- 德国全国诊断相关群体统计数据的回顾性分析,涉及86,073名接受胰腺切除的患者.
- 大容量胰腺中心 (HVPC) 的定义是每年进行≥50次切除的医院.
- 风险调整使用一个一般化的混合模型来调整患者人口统计,诊断和并发症.
主要成果:
- 在23名HVPC患者中,发生了24.2%的胰腺切除,其原始住院死亡率为5.5%,而非HVPC患者的死亡率为10.1% (P < 0.001).
- 医疗保健医生进行了更复杂的手术,但治疗了较年轻的患者,并患有较少的并发症.
- 在对患者因素进行统计调整后,HVPC患者的住院死亡率从5.5%增加到8.7%.
结论:
- 大量的胰腺中心显示出明显较低的住院死亡率.
- 改善的结果受到专业专业知识和HVPC中更健康的患者群体的影响.
- 在HVPC中患者选择偏差的程度需要进一步调查.
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