Ninety day mortality following pancreatoduodenectomy in England: has the optimum centre volume been identified?

Ninety day mortality following pancreatoduodenectomy in England: has the optimum centre volume been identified?
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DOI：
10.1016/j.hpb.2018.04.008
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发表时间：
2018-11-01
期刊：
HPB
影响因子：
2.9
通讯作者：
Roberts, K. J.
Roberts, K. J.
中科院分区：
医学3区
文献类型：
--
作者：
Liu, Z.;Peneva, I. S.;Roberts, K. J.

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背景：胰十二指肠切除术后的死亡率与中心容积有关，但最佳容积尚未确定。方法：从英国国家数据库中确定2001年至2016年期间接受PD治疗的患者。研究了患者变量、中心容积和时间对90天死亡率的影响。结果：90天死亡率（970/ 14935,6.5%）与高龄、合并症、诊断、种族、剥夺、中心容积和时间有关。死亡率从2001-4年的10.0%显著下降到2013-16年的4.1%。高容量中心（每年36-60 PD）和非常高容量中心（每年60 -60 PD）的90天死亡率没有差异。然而，在容量非常大的中心接受手术的患者更多是老年人（66,58 -73 vs 65,56 -72；中位数，IQR; p = 0.006），贫困（38.7 vs 34.6%; p < 0.001）和合并症（48.9 vs 46.1%, p = 0.027）。结论：虽然中心容量和死亡率之间的平台关系似乎已被证明，但在最高容量中心接受治疗的患者死亡风险更高。因此，这些数据表明，为了进一步了解专科中心的结果，应该定义患者群体的特征，而不仅仅是中心容量。
Background: Mortality following pancreatoduodenectomy is related to centre volume although the optimal volume is not defined.Methods: Patients undergoing PD between 2001 and 2016 were identified from UK national databases. The effects of patient variables, centre volume and time period upon 90 day mortality were studied.Results: 90 day mortality (970/14,935,6.5%) was related to advanced age, comorbidity, diagnosis, ethnicity, deprivation, centre volume and time period. Mortality rates fell markedly from 10.0% in 2001-4 to 4.1% in 2013-16. There was no difference in 90 day mortality between high (36-60 PD per year) and very high volume (>60) centres. However, patients operated upon at very high volume centres were more elderly (66, 58 -73 vs 65, 56 -72; median, IQR; p = 0.006), deprived (38.7 vs 34.6%; p < 0.001) and co morbid (48.9 vs 46.1%; p = 0.027).Conclusion: Although a plateau in the centre volume and mortality relationship appears to have been demonstrated those patients treated at the highest volume centres were at higher risk of mortality. This data suggests therefore that to further understand outcomes from specialist centres characteristics of the patient population should be defined, not just centre volume.