RECENT RESULTS OF ELECTIVE OPEN CHOLECYSTECTOMY IN A NORTH-AMERICAN AND A EUROPEAN CENTER - COMPARISON OF COMPLICATIONS AND RISK-FACTORS
RECENT RESULTS OF ELECTIVE OPEN CHOLECYSTECTOMY IN A NORTH-AMERICAN AND A EUROPEAN CENTER - COMPARISON OF COMPLICATIONS AND RISK-FACTORS
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DOI：
10.1097/00000658-199212000-00002
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发表时间：
1992-12-01
影响因子：
9
通讯作者：
STRASBERG, SM
中科院分区：
文献类型：
--
作者：
CLAVIEN, PA;SANABRIA, JR;STRASBERG, SM
对北美和欧洲一家中心1252名患者的择期开腹胆囊切除术的结果进行了检查，采用了最新的并发症标准化分类。尽管不同中心在人口年龄、伴发疾病发生率和手术人数上有显著差异，但并发症的频率和严重程度是可比的。没有死亡病例，但两个中心分别有12%和14%的患者出现并发症。约6%的患者出现I级并发症。II级并发症发生率为6%和8%，III级并发症发生率为0%和0.3%。使用单变量和多变量分析，发现两个中心发生并发症的个体危险因素不同。两个术前评分系统，ASA和简化的APACHE II评分系统，对两个中心的并发症都有预测作用，但没有考虑到这些患者的所有风险。这两个中心的数据无法合并，因为风险因素和中心之间存在显著的交互作用。择期开腹胆囊切除术是一种安全的手术，尤其是在并发症和死亡率很高的情况下。在特定中心确定的风险因素的泛化可能具有误导性，因为当地条件可能显著影响并发症的风险因素。这些数据还表明了报告手术并发症的统一方式的优势，这可能允许在不同中心之间进行有意义的比较。
Results of elective open cholecystectomy in 1252 patients treated in a North American and a European center were examined using a recent standardized classification of complications. Although there were significant differences between centers in population age, rate of concomitant disorders, and numbers of operators, the frequency and severity of complications were comparable. There were no deaths, but 12% and 14% of the patients developed complications in the two centers. About 6% of the patients developed grade I complications. Grade II complications were noted in 6% and 8%, and grade III in 0% and 0.3%. Using univariate and multivariate analysis, individual risk factors for developing complications were found to be different in the two centers. Two preoperative scoring systems, ASA and a simplified APACHE II, were predictive for complications in both centers, but did not account for all risk in these patients. Data from the two centers could not be combined because of significant interaction between risk factors and center. Elective open cholecystectomy is a safe procedure, particularly in terms of highly morbid complications and death. Generalization of risk factors identified in a particular center may be misleading because local conditions may significantly affect risk factors for complications. The data also demonstrate the advantages of a uniform way of reporting surgical complications, which may permit meaningful comparisons among centers.