Morbidity of urologic surgical procedures: an analysis of rates, risk factors, and outcomes.
Morbidity of urologic surgical procedures: an analysis of rates, risk factors, and outcomes.
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DOI：
10.1016/j.urology.2014.11.034
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发表时间：
2015-03
期刊：
影响因子：
2.1
通讯作者：
Allaf ME
中科院分区：
文献类型：
--
作者：
Patel HD;Ball MW;Cohen JE;Kates M;Pierorazio PM;Allaf ME
量化全国范围内各种泌尿外科手术的并发症发生率、围手术期结局和预测因素，以证明背景发生率并讨论基准。对NSQIP（2006-2011）的泌尿外科手术进行了分析，以确定30天内21种并发症的发生率、结局（住院时间（LOS）、再手术、死亡）和预测因素，包括住院医师参与18种特定手术的情况。多变量逻辑回归模型评估了任何并发症和Clavien IV或V并发症的预测因素。共纳入39，700例手术，其中腹盆手术比内窥镜、阴囊、失禁或脱垂手术更病态。Cybery的发病率最高（10.8天LOS，3.2%死亡率），56%发生任何并发症，其次是肾切除术（21%），RPLND（20%）和RRP（19%）。TURBT（11%）和TURP（10%）在内镜手术中的发生率最高。年龄较大、阿萨分级、依赖性功能状态、阿基[OR 2.70（1.89-3.87）]和术前输血≥5单位[OR 4.44（3.40-5.80）]是任何并发症的最强预测因素。相似预测因子的较高OR沿着COPD [OR 1.52（1.21-1.92）]和类固醇使用[OR 1.51（1.07-2.14）]与Clavien IV或V并发症相关。住院医生参与增加了任何并发症的几率[OR 1.18（1.09-1.29）]，主要是腹盆和泌尿妇科手术，但不是Clavien IV或V并发症（p=0.55）。基于少数外科医生的回顾性经验，泌尿外科手术的并发症发生率不允许进行适当的基准测试。从NSQIP得出的基线率和基准可以帮助医院更好地跟踪缺陷区域和护理质量的改善。许多预测因素在不同手术中相似，但幅度不同，住院实习生不会影响严重并发症的发生率（Clavien-Dindo IV级或V级）。
To quantify national complication rates, perioperative outcomes, and predictors for a broad range of urological procedures to demonstrate background rates and discuss benchmarking. Urologic procedures from NSQIP (2006–2011) were analyzed to identify 30-day rates of 21 complications, outcomes (length of stay (LOS), reoperation, death), and predictors including resident involvement for 18 specific procedures. Multivariable logistic regression models assessed predictors for any complication and for Clavien IV or V complication. A total of 39,700 procedures were included with abdominopelvic operations more morbid than endoscopic, scrotal, incontinence, or prolapse procedures. Cystectomy had the highest morbidity (10.8 days LOS, 3.2% mortality) with 56% experiencing any complication followed by nephrectomy (21%), RPLND (20%), and RRP (19%). TURBT (11%) and TURP (10%) had highest rates for endoscopic procedures. Older age, ASA class, dependent functional status, AKI [OR2.70(1.89–3.87)], and ≥5 units preoperative transfusion [OR4.44(3.40–5.80)] were strongest predictors of any complication. Higher ORs of similar predictors along with COPD [OR1.52(1.21–1.92)] and steroid use [OR1.51(1.07–2.14)] were associated with Clavien IV or V complication. Resident involvement increased odds of any complication [OR1.18(1.09–1.29)], mostly for abdominopelvic and urogynecologic procedures, but not Clavien IV or V complication (p=0.55). Complication rates of urological procedures based on the retrospective experience of few surgeons does not allow for appropriate benchmarking. Baseline rates and benchmarks derived from NSQIP may help hospitals better track deficient areas and improvements in quality of care. Many predictors were similar across procedures, although magnitudes differed, and resident trainees did not impact rates of serious complications (Clavien-Dindo grade IV or V).
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影响因子：
3.8
作者：
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通讯作者：
Tubaro, A.
影响因子：
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Allaf ME
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