A Pancreaticoduodenectomy Risk Model Derived From 8575 Cases From a National Single-Race Population (Japanese) Using a Web-Based Data Entry System The 30-Day and In-hospital Mortality Rates for Pancreaticoduodenectomy
A Pancreaticoduodenectomy Risk Model Derived From 8575 Cases From a National Single-Race Population (Japanese) Using a Web-Based Data Entry System The 30-Day and In-hospital Mortality Rates for Pancreaticoduodenectomy
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DOI：
10.1097/sla.0000000000000263
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发表时间：
2014-04-01
影响因子：
9
通讯作者：
Mori, Masaki
中科院分区：
文献类型：
--
作者：
Kimura, Wataru;Miyata, Hiroaki;Mori, Masaki
目的：利用基于Web的国家数据库系统建立胰腺十二指肠切除术(PD)后死亡风险模型。背景：PD是一种死亡率较高的主要胃肠外科手术。许多研究已经报道了分析短期结果的因素。对象和方法：国家临床数据库建立后，通过基于Web的数据录入系统收集了来自日本3500多家医院的约120万例手术病例。对2011年1167家医院记录的8575例帕金森病患者(平均年龄68.2岁)进行数据清理后，采用与美国外科医师学会-国家外科质量改进计划基本一致的变量和定义进行分析。结果：术后30d死亡率为1.2%，住院病死率为2.8%(103例和239例)。确定了13个导致住院死亡的重要危险因素：年龄、呼吸窘迫、术前30天内的日常生活活动、心绞痛、体重减轻超过10%、美国麻醉医师协会分级大于3、布林克曼指数超过400、体重指数超过25 kg/m(2)、每微升白细胞数超过11,000个、血小板计数低于每微升120,000个、凝血酶原时间/国际标准化比率超过1.1、部分凝血活酶激活时间超过40秒以及血清肌酐水平超过3.0 mg/dL。在30天死亡率组中，包括男性性别、紧急手术、慢性阻塞性肺疾病、出血性疾病和血清尿素氮水平低于8.0 mg/dL在内的5个变量是自变量。帕金森病并发症发生率为40.0%。国际胰瘘研究组B、C级胰瘘发生率为13.2%。胰腺癌患者的30天死亡率和住院死亡率显著低于非胰腺癌患者。结论：我们使用全国性的外科数据库进行了帕金森病的风险分层研究。PD在全国人群中的结果是令人满意的，风险模型可以帮助提高外科实践的质量。
Objective: To create a mortality risk model after pancreaticoduodenectomy (PD) using a Web-based national database system.Background: PD is a major gastroenterological surgery with relatively high mortality. Many studies have reported factors to analyze short-term outcomes.Subjects and Methods: After initiation of National Clinical Database, approximately 1.2 million surgical cases from more than 3500 Japanese hospitals were collected through a Web-based data entry system. After data cleanup, 8575 PD patients (mean age, 68.2 years) recorded in 2011 from 1167 hospitals were analyzed using variables and definitions almost identical to those of American College of Surgeons-National Surgical Quality Improvement Program.Results: The 30-day postoperative and in-hospital mortality rates were 1.2% and 2.8% (103 and 239 patients), respectively. Thirteen significant risk factors for in-hospital mortality were identified: age, respiratory distress, activities of daily living within 30 days before surgery, angina, weight loss of more than 10%, American Society of Anesthesiologists class of greater than 3, Brinkman index of more than 400, body mass index of more than 25 kg/m(2), white blood cell count of more than 11,000 cells per microliter, platelet count of less than 120,000 per microliter, prothrombin time/international normalized ratio of more than 1.1, activated partial thromboplastin time of more than 40 seconds, and serum creatinine levels of more than 3.0 mg/dL. Five variables, including male sex, emergency surgery, chronic obstructive pulmonary disease, bleeding disorders, and serum urea nitrogen levels of less than 8.0 mg/dL, were independent variables in the 30-day mortality group. The overall PD complication rate was 40.0%. Grade B and C pancreatic fistulas in the International Study Group on Pancreatic Fistula occurred in 13.2% cases. The 30-day and in-hospital mortality rates for pancreatic cancer were significantly lower than those for nonpancreatic cancer.Conclusions: We conducted the reported risk stratification study for PD using a nationwide surgical database. PD outcomes in the national population were satisfactory, and the risk model could help improve surgical practice quality.