Grading of Surgeon Technical Performance Predicts Postoperative Pancreatic Fistula for Pancreaticoduodenectomy Independent of Patient-related Variables
Grading of Surgeon Technical Performance Predicts Postoperative Pancreatic Fistula for Pancreaticoduodenectomy Independent of Patient-related Variables
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DOI：
10.1097/sla.0000000000001862
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发表时间：
2016-09-01
影响因子：
9
通讯作者：
Zeh, Herbert J., III
中科院分区：
文献类型：
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作者：
Hogg, Melissa E.;Zenati, Mazen;Zeh, Herbert J., III
目的：通过对机器人胰十二指肠切除术（rpd）胰空肠吻合术的手术效果进行评分，评价和量化手术技巧。我们假设手术表现的视频分级有助于估计胰十二指肠切除术后胰瘘（POPF）的风险。背景：POPF是胰十二指肠切除术发病率的主要原因。从患者变量中得出的风险评分[瘘风险评分（FRS）和Braga]可用于预测POPF。Birkmeyer等人表明，手术熟练程度的评估是预后的重要组成部分。方法：采用国际研究组定义诊断POPF。2位盲法外科医生对机器人胰空肠吻合术视频的技术性能进行评分：(1)胰空肠吻合术步进变量[pj特异性变量（PJVs）]；Max = 115]；(2)技术技能客观结构化评估（OSATS）分数。结果：分析了133例胰空肠吻合术。POPF为18%。较高的FRS （P = 0.011）和Braga （P = 0.041）分数预测POPF。评分者的主观预测与FRS/Braga得分无关。1级评分预测POPF (P = 0.043)，但2级评分不预测POPF （P = 0.44）。PJV评分bb0 ~ 105可预测POPF （P = 0.039）。仅对PJV导管至粘膜缝数（max = 50）进行评分可高度预测POPF （P = 0.0053）。较高的OSATS评分与较低的POPF发生率相关（P = 0.022）。在多变量分析中，对具有统计学意义的患者变量（如腺体质地）加入技术评分可以改进模型，并能独立预测POPF。软腺体（优势比= 18.28,95%可信区间= 2.19-152.57）和低OSATS（优势比= 0.82,95%可信区间= 0.70-0.96）是POPF最强的预测模型。以FRS或Braga分数为模型的OSATS独立地预测了POPF。结论：这是第一个证明外科医生表现的技术评分独立预测胰腺手术患者预后的研究。未来的研究应该考虑如何验证和合并技术度量。
Objective: To evaluate and quantify surgical skill by grading surgical performance of the pancreaticojejunostomy from robotic pancreaticoduodenectomies (RPDs). We hypothesized that video grading of surgical performance would contribute to estimating risk of postoperative pancreatic fistula (POPF) after pancreaticoduodenectomy.Background: POPF majorly contributes to pancreaticoduodenectomy morbidity. Risk scores [Fistula Risk Score (FRS) and Braga] derived from patient variables are validated for predicting POPF. Birkmeyer et al showed assessment of surgical proficiency is an important component of outcomes.Methods: POPF was diagnosed using International Study Group definition. Technical performance of robotic pancreaticojejunostomy video was graded by 2 blinded surgeons using: (1) pancreaticojejunostomy step-by-step variables [PJ-specific variables (PJVs); max = 115]; and (2) the Objective Structured Assessment of Technical Skills (OSATS) score.Results: One hundred thirty-three pancreaticojejunostomies were analyzed. POPF was 18%. Higher FRS (P = 0.011) and Braga (P = 0.041) scores predicted POPF. Graders' subjective prediction did not correlate with FRS/Braga scores. Grader 1 scores (P = 0.043), but not grader 2 (P = 0.44), predicted POPF. PJV scores >105 were predictive of POPF (P = 0.039). Scoring only PJV duct-to-mucosa stitches (max = 50) was highly predictive of POPF (P = 0.0053). Higher OSATS scores were associated with a decreased rate of POPF (P = 0.022). On multivariate analysis, adding technical scoring to statistically significant patient variables (ie, gland texture) improves the model and can independently predict POPF. The strongest predictive model for POPF consisted of soft gland (odds ratio = 18.28, 95% confidence interval = 2.19-152.57) and low OSATS (odds ratio = 0.82, 95% confidence interval = 0.70-0.96). OSATS, modeled with FRS or Braga scores, independently predicted POPF.Conclusions: This is the first study to demonstrate that technical scoring of a surgeon's performance independently predicts patient outcomes in pancreatic surgery. Future studies should consider how to validate and incorporate technical metrics.