Variation in Hospital Utilization of Minimally Invasive Distal Pancreatectomy for Localized Pancreatic Neoplasms.
Variation in Hospital Utilization of Minimally Invasive Distal Pancreatectomy for Localized Pancreatic Neoplasms.
复制标题
用于局部胰腺肿瘤的微创远端胰腺切除术的医院利用率变化。
DOI：
10.1007/s11605-019-04414-7
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发表时间：
2020-12
期刊：
影响因子：
--
通讯作者：
Merkow RP
中科院分区：
文献类型：
--
作者：
Ellis RJ;Zhang LM;Ko CY;Cohen ME;Bentrem DJ;Bilimoria KY;Yang AD;Talamonti MS;Merkow RP
微创远端胰腺切除术（MIDP）治疗局限性肿瘤已被证明是可行和安全的。然而，对各国采用该技术的情况知之甚少。本研究的目的是确定与使用微创胰腺远端切除术治疗局部肿瘤相关的因素，并评估MIDP使用的医院差异。ACS NSQIP胰腺靶向数据集中接受胰腺远端切除术的胰腺囊肿、I期胰腺导管腺癌和I期胰腺神经内分泌肿瘤患者的回顾性队列研究。使用多变量逻辑回归确定与MIDP使用相关的因素，并评估医院水平的差异。分析包括139家医院的3，059名患者。总体而言，64.5%的患者接受了微创远端胰腺切除术。阿萨分级较低（P = 0.004）或BMI ≥ 30（P < 0.001）的患者更容易接受MIDP，而胰腺癌患者则不太可能接受MIDP（P < 0.001）。利用率存在显著的医院差异（范围为0 - 100%病例）。微创胰体尾切除术的医院水平利用似乎不受患者选择的驱动，因为分层分析表明，观察到的医院变化中只有1.8%可归因于测量的患者选择因素。MIDP在局部胰腺肿瘤中的应用是高度可变的。虽然一些患者层面的因素与MIDP的使用相关，但医院采用MIDP似乎是利用率的主要驱动因素。监测MIDP的医院级使用可能是一个有用的质量指标，以监测胰腺外科新兴技术的吸收。
Minimally invasive distal pancreatectomy (MIDP) for localized neoplasms has been demonstrated to be feasible and safe. However, national adoption of the technique is poorly understood. Objectives of this study were to identify factors associated with use of minimally invasive distal pancreatectomy for localized neoplasms and assess hospital variation in MIDP utilization. Retrospective cohort study of patients with pancreatic cysts, stage I pancreatic ductal adenocarcinoma, and stage I pancreatic neuroendocrine tumors undergoing distal pancreatectomy from the ACS NSQIP Pancreas Targeted Dataset. Factors associated with use of MIDP were identified using multivariable logistic regression and hospital-level variation was assessed. Analysis included 3,059 patients at 139 hospitals. Overall, 64.5% of patients underwent minimally invasive distal pancreatectomy. Patients were more likely to undergo MIDP if they had lower ASA classification (P = 0.004) or BMI ≥ 30 (P < 0.001) and less likely if they had pancreatic adenocarcinoma (P < 0.001). There was notable hospital variability in utilization (range 0 to 100% of cases). Hospital-level utilization of minimally invasive distal pancreatectomy did not appear to be driven by patient selection, as hierarchical analysis demonstrated that only 1.8% of observed hospital variation was attributable to measured patient selection factors. Utilization of MIDP for localized pancreatic neoplasms is highly variable. While some patient-level factors are associated with MIDP use, hospital adoption of MIDP appears to be the primary driver of utilization. Monitoring hospital-level use of MIDP may be a useful quality measure to monitor uptake of emerging techniques in pancreatic surgery.
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影响因子：
3.2
作者：
Baker, Marshall S.;Sherman, Karen L.;Talamonti, Mark S.
通讯作者：
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作者：
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