ACS-NSQIP has the potential to create an HPB-NSQIP option
ACS-NSQIP has the potential to create an HPB-NSQIP option
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DOI：
10.1111/j.1477-2574.2009.00074.x
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发表时间：
2009-08-01
期刊：
影响因子：
2.9
通讯作者：
Mulvihill, Sean J.
中科院分区：
文献类型：
--
作者：
Pitt, Henry A.;Kilbane, Molly;Mulvihill, Sean J.
背景：美国外科医师学会国家外科质量改进计划（ACS - NSQIP）始于2004年。目前，参与ACS - NSQIP的198家医院中有58%是学术性或教学医院。2008年，ACS - NSQIP进行了一系列变革，并使风险调整后的数据可供参与医院使用。本分析探讨ACS - NSQIP数据库在制定肝胰胆（HPB）手术特定结果（HPB - NSQIP）方面的实用性。
方法：查询ACS - NSQIP参与者使用文件，获取2005年1月1日至2007年12月31日期间49种肝胰胆手术的患者人口统计学资料和手术结果。这些手术包括6种肝脏手术、16种胰腺手术和23种复杂胆道手术。还研究了4种腹腔镜或开腹胆囊切除术。将每种手术的发病率和死亡率的风险调整概率与观察到的比率进行比较。
结果：在这36个月期间，收集了9723例接受主要肝胰胆手术患者以及44189例接受胆囊切除术患者的数据。主要的肝胰胆手术包括2847例肝脏手术（29%）、5074例胰腺手术（52%）和1802例复杂胆道手术（19%）。接受肝脏切除术的患者更有可能患有转移性疾病（42%）和近期接受过化疗（7%），而接受复杂胆道手术的患者更有可能出现明显体重减轻（20%）、糖尿病（13%）和腹水（5%）。肝脏、胰腺和复杂胆道手术的发病率较高（分别为20.1%、32.4%和21.2%），而死亡率较低（分别为2.3%、2.7%和2.7%）。与腹腔镜胆囊切除术相比，开腹手术的发病率（19.2%对6.0%）和死亡率（2.5%对0.3%）更高。观察到的与预期的发病率和死亡率之比为……
Background: The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was started in 2004. Presently, 58% of the 198 hospitals participating in ACS-NSQIP are academic or teaching hospitals. In 2008, ACS-NSQIP initiated a number of changes and made risk-adjusted data available for use by participating hospitals. This analysis explores the ACS-NSQIP database for utility in developing hepato-pancreato-biliary (HPB) surgery-specific outcomes (HPB-NSQIP).Methods: The ACS-NSQIP Participant Use File was queried for patient demographics and outcomes for 49 HPB operations from 1 January 2005 through 31 December 2007. The procedures included six hepatic, 16 pancreatic and 23 complex biliary operations. Four laparoscopic or open cholecystectomy operations were also studied. Risk-adjusted probabilities for morbidity and mortality were compared with observed rates for each operation.Results: During this 36-month period, data were accumulated on 9723 patients who underwent major HPB surgery, as well as on 44 189 who received cholecystectomies. The major HPB operations included 2847 hepatic (29%), 5074 pancreatic (52%) and 1802 complex biliary (19%) procedures. Patients undergoing hepatic resections were more likely to have metastatic disease (42%) and recent chemotherapy (7%), whereas those undergoing complex biliary procedures were more likely to have significant weight loss (20%), diabetes (13%) and ascites (5%). Morbidity was high for hepatic, pancreatic and complex biliary operations (20.1%, 32.4% and 21.2%, respectively), whereas mortality was low (2.3%, 2.7% and 2.7%, respectively). Compared with laparoscopic cholecystectomy, the open operation was associated with higher rates of morbidity (19.2% vs. 6.0%) and mortality (2.5% vs. 0.3%). The ratios between observed and expected morbidity and mortality rates were