Defining Quality for Distal Pancreatectomy: Does the Laparoscopic Approach Protect Patients from Poor Quality Outcomes?
Defining Quality for Distal Pancreatectomy: Does the Laparoscopic Approach Protect Patients from Poor Quality Outcomes?
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DOI：
10.1007/s11605-012-2104-2
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发表时间：
2013-02-01
影响因子：
3.2
通讯作者：
Talamonti, Mark S.
中科院分区：
文献类型：
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作者：
Baker, Marshall S.;Sherman, Karen L.;Talamonti, Mark S.
当需要多次干预或再入院来管理并发症时，已建立的术后并发症分级系统不会改变指定的等级。使用这些系统的研究可能会歪曲正在评价的外科手术的结局。我们定义了远端胰腺切除术（DP）的质量结果，并使用该指标比较腹腔镜远端胰腺切除术（LDP）和开放式远端胰腺切除术（ODP）。Clavien-Dindo IIIb、IV和V级并发症被分类为严重不良-质量差-术后结局（SAPO）。II和IIIa型并发症需要显著延长总住院时间，包括90天内再入院或超过一次侵入性干预，也被归类为SAPOs. Clavien-Dindo系统单独，91%的DP患者没有并发症或低/中度（I，II，IIIa）并发症。然而，使用我们的重新分类，25%的人有SAPO。接受LDP的患者表现出与SDP相同的Clavien-Dindo并发症特征，但总体住院时间明显缩短，不太可能需要围手术期输血，也不太可能发生SAPO.Established系统低估了DP后某些并发症的严重程度。使用特定于手术的质量指标，我们证明LDP提供了比ODP更高质量的术后结局。
Established systems for grading postoperative complications do not change the assigned grade when multiple interventions or readmissions are required to manage a complication. Studies using these systems may misrepresent outcomes for the surgical procedures being evaluated. We define a quality outcome for distal pancreatectomy (DP) and use this metric to compare laparoscopic distal pancreatectomy (LDP) to open distal pancreatectomy (ODP).Records for patients undergoing DP between January 2006 and December 2009 were reviewed. Clavien-Dindo grade IIIb, IV, and V complications were classified as severe adverse-poor quality-postoperative outcomes (SAPOs). II and IIIa complications requiring either significantly prolonged overall lengths of stay including readmissions within 90 days or more than one invasive intervention were also classified as SAPOs.By Clavien-Dindo system alone, 91 % of DP patients had either no complication or a low/moderate grade (I, II, IIIa) complication. Using our reclassification, however, 25 % had a SAPO. Patients undergoing LDP demonstrated a Clavien-Dindo complication profile identical to that for SDP but demonstrated significantly shorter overall lengths of stay, were less likely to require perioperative transfusion, and less likely to have a SAPO.Established systems undergrade the severity of some complications following DP. Using a procedure-specific metric for quality, we demonstrate that LDP affords a higher quality postoperative outcome than ODP.