Ten-year experience with 733 pancreatic resections - Changing indications, older patients, and decreasing length of hospitalization
Ten-year experience with 733 pancreatic resections - Changing indications, older patients, and decreasing length of hospitalization
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DOI：
10.1001/archsurg.136.4.391
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发表时间：
2001-04-01
影响因子：
--
通讯作者：
Fernandez-del Castillo, C
中科院分区：
文献类型：
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作者：
Balcom, JH;Rattner, DW;Fernandez-del Castillo, C
假设：过去10年的胰腺切除术经验导致患者特征出现新趋势，胰腺切除术（PD）的住院时间（LOS）缩短。这一下降是由于生病的一部分，实施的情况下管理和临床pathways.Design：回顾性病例系列的病人接受胰腺切除术。该研究包括1990年4月至2000年3月在波士顿马萨诸塞州总医院因良性或恶性疾病接受胰腺切除术的733名连续患者。在733例胰腺切除术中，489例为PD; 190例为远端胰腺切除术; 40例为全胰腺切除术; 14例为中段胰腺切除术。主要结果指标：住院时间胃排空延迟、胰瘘、再次手术、再次入院或其他并发症的发生率;按病例管理实施3个时期患者死亡率及比较（1995年7月）和临床路径（1998年9月）。对于PD，第1组患者（1990年4月至1995年6月）（平均值+/- SD，57 +/- 15岁）（1995年7月至1998年8月;平均值±标准差，62 ± 13岁）和第3组（1998年9月至2000年10月;平均值±标准差，65 ± 13岁）（P
Hypothesis: Experience with pancreatic resection for the last 10 years has resulted in new trends in patient characteristics and, for pancreaticoduodenectomy (PD), a decrease in the length of stay (LOS). This decrease is due ill part to the implementation of case management and clinical pathways.Design: Retrospective case series of patients undergoing pancreatic resection.Setting: A university-affiliated, tertiary care referral center.Patients: The study comprised 733 consecutive patients undergoing, pancreatic resection for benign or malignant disease at the Massachusetts General Hospital ill Boston from April 1990 to March 2000.Interventions: Of the 733 pancreatic resections, 489 were PD; 190, distal pancreatectomy; 40, total pancreatectomy; and 14, middle-segment pancreatectomy.Main Outcome Measures: Length of stay occurrence of delayed gastric emptying, pancreatic fistula, reoperation, readmission, or other complications; mortality and comparison of patients in 3 periods according to the implementation of case management (July 1995) and clinical pathways (September 1998).Results: For PD, patients in group 1 (April 1990 to June 1995) were significantly younger (mean +/- SD, 57 +/- 15 years) than those in group 2 (July 1995 to August 1998; mean +/- SD, 62 +/- 13 years) and group 3 (September 1998 to October 2000; mean +/- SD, 65 +/- 13 years)(P