Technical Performance as a Predictor of Clinical Outcomes in Laparoscopic Gastric Cancer Surgery
Technical Performance as a Predictor of Clinical Outcomes in Laparoscopic Gastric Cancer Surgery
复制标题
预测腹腔镜胃癌手术临床效果的技术性能
DOI：
10.1097/sla.0000000000002741
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发表时间：
2019-07-01
影响因子：
9
通讯作者：
Grantcharov, Teodor P.
中科院分区：
文献类型：
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作者：
Fecso, Andras B.;Bhatti, Junaid A.;Grantcharov, Teodor P.
目的：本研究的目的是评估腹腔镜胃癌手术技术性能与患者预后的关系。背景：腹腔镜胃癌切除术是一种晚期手术，术后发病率和死亡率高。包括患者、疾病和围手术期管理因素在内的许多变量已被证明会影响术后结果；然而，手术表现的作用尚未得到充分研究。方法：回顾性分析2009 - 2015年3所教学机构腹腔镜胃癌切除术患者的资料。有可用的、未经编辑的手术视频记录的患者被纳入研究。使用客观结构化技术技能评估（OSATS）和通用错误评级工具对视频文件的技术性能进行评级。主要结局变量为主要短期并发症。技术表现对患者预后的影响采用logistic回归分析和逆向选择策略进行评估。结果：61例有录像资料的患者被纳入研究。总并发症发生率为29.5%。最终的预测模型包括平均Charlson合并症指数、手术类型和总体OSATS评分。较低的性能分数（OSATS）
Objective: The purpose of this study was to evaluate the relationship between technical performance and patient outcomes in laparoscopic gastric cancer surgery.Background: Laparoscopic gastrectomy for cancer is an advanced procedure with high rate of postoperative morbidity and mortality. Many variables including patient, disease, and perioperative management factors have been shown to impact postoperative outcomes; however, the role of surgical performance is insufficiently investigated.Methods: A retrospective review was performed for all patients who had undergone laparoscopic gastrectomy for cancer at 3 teaching institutions between 2009 and 2015. Patients with available, unedited video-recording of their procedure were included in the study. Video files were rated for technical performance, using Objective Structured Assessments of Technical Skills (OSATS) and Generic Error Rating Tool instruments. The main outcome variable was major short-term complications. The effect of technical performance on patient outcomes was assessed using logistic regression analysis with backward selection strategy.Results: Sixty-one patients with available video recordings were included in the study. The overall complication rate was 29.5%. The mean Charlson comorbidity index, type of procedure, and the global OSATS score were included in the final predictive model. Lower performance score (OSATS