Improved Perioperative Outcomes With Minimally Invasive Distal Pancreatectomy Results From a Population-Based Analysis
Improved Perioperative Outcomes With Minimally Invasive Distal Pancreatectomy Results From a Population-Based Analysis
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DOI：
10.1001/jamasurg.2013.3202
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发表时间：
2014-03-01
期刊：
影响因子：
16.9
通讯作者：
Sicklick, Jason K.
中科院分区：
文献类型：
--
作者：
Cao, Hop S. Tran;Lopez, Nicole;Sicklick, Jason K.
近年来，人们对微创远端胰腺切除术（MIDP）的兴趣越来越大，但目前可用的数据有限。可以从国家数据库查询中获得对应用程序模式和结果的更深入的了解。目的研究MIDP的应用趋势，比较MIDP与远端胰腺切除术的短期疗效。设计、环境和参与者：基于人群的回顾性队列研究评估远端胰腺切除术的围手术期结果和医院收费措施，比较手术入路并调整患者和医院水平的因素，在1998年至2009年的全国住院患者样本中，在所有美国医院的20%分层样本中进行选择性远端胰腺切除术。主要结局和指标住院死亡率、围手术期并发症和脾切除术发生率、总费用和住院时间。结果共纳入8957例远端胰腺切除术，其中382例（4.3%）为midp。在全国范围内，预计有42 320例远端胰腺切除术和1908例midp。经微创入路行远端胰腺切除术的比例在1998年至2009年间增加了两倍，从2.4%增至7.3%。两组在性别和合并症方面具有可比性，而接受MIDP的患者年龄为1.5岁。在多变量分析中，MIDP与较低的总体出院前并发症发生率相关，包括较低的术后感染和出血并发症发生率，以及较短的住院时间1.22天。两组在住院死亡率、合并性脾切除术或总费用方面没有差异。结论和相关性这项基于人群的MIDP研究表明，该方法的应用在实践中增加了两倍，并提供了强有力的证据，证明MIDP已发展成为治疗良性和恶性胰腺疾病的安全选择。
IMPORTANCE Interest in minimally invasive distal pancreatectomy (MIDP) has grown in recent years, but currently available data are limited. Greater insight into application patterns and outcomes may be gained from a national database inquiry.OBJECTIVES To study trends in the use of MIDP and compare the short-term outcomes of MIDP with those of open distal pancreatectomy.DESIGN, SETTING, AND PARTICIPANTS Population-based retrospective cohort study evaluating perioperative outcomes and hospital charge measures for distal pancreatectomy, comparing the surgical approaches and adjusting for patient-and hospital-level factors, among patients undergoing elective distal pancreatectomy from 1998 to 2009 in the Nationwide Inpatient Sample in a 20% stratified sample of all US hospitals.MAIN OUTCOMES AND MEASURES In-hospital mortality, rates of perioperative complications and splenectomy, total charges, and length of stay.RESULTS A total of 8957 distal pancreatectomies were included in this analysis, of which 382 (4.3%) were MIDPs. On a national level, this projected to 42 320 open distal pancreatectomies and 1908 MIDPs. The proportion of distal pancreatectomies performed via minimally invasive approaches tripled between 1998 and 2009, from 2.4% to 7.3%. The groups were comparable for sex and comorbidity profiles, while patients who underwent MIDP were 1.5 years older. On multivariate analysis, MIDP was associated with lower rates of overall predischarge complications, including lower incidences of postoperative infections and bleeding complications, as well as a shorter length of stay by 1.22 days. There were no differences in rates of in-hospital mortality, concomitant splenectomy, or total charges.CONCLUSIONS AND RELEVANCE This population-based study of MIDP reveals that the application of this approach has tripled in practice and provides strong evidence that MIDP has evolved into a safe option in the treatment of benign and malignant pancreatic diseases.