Quality indicators, including complications, of ERCP in a community setting: a prospective study
Quality indicators, including complications, of ERCP in a community setting: a prospective study
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DOI：
10.1016/j.gie.2008.11.022
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发表时间：
2009-09-01
影响因子：
7.7
通讯作者：
Curran, Colleen C.
中科院分区：
文献类型：
--
作者：
Colton, Joshua B.;Curran, Colleen C.
背景：尚无大型研究记录社区实践中 ERCP 的质量结果和并发症发生率。美国胃肠内窥镜协会 (ASGE)/美国胃肠病学学院质量工作组提出了有关社区实践中 ERCP 的 5 个问题。 ASGE 结果研究委员会建议使用 8 个 ERCP 特定质量指标来更好地衡量 ERCP 的质量目标：确定社区实践中的 ERCP 质量结果，包括并发症。设计：前瞻性研究背景：明尼阿波利斯-圣路易斯的八家社区医院。明尼苏达州保罗地区。患者：2005 年 12 月 1 日至 2006 年 7 月 31 日期间，每位接受明尼苏达胃肠病学 PA 进行 ERCP 的患者。主要结果测量：ASGE 推荐的质量指标，特别是 30 天并发症发生率。结果：696 名患者总共进行了 805 次 ERCP 手术。治疗性ERCP占78.4%。并发症发生率为 5.0%（治疗过程中为 5.7%，诊断过程中为 2.3%）。胰腺炎发生在 3.2% 的手术中（治疗手术中 3.6%，诊断手术中 1.7%）。仅在ERCP治疗后发生感染（0.75%）、出血（0.62%）和穿孔（0.12%）。2名患者（0.25%）出现心肺并发症。括约肌预切开术26例（3.2%），Oddi括约肌测压23例（2.9%）。胆道插管成功率为94.0%，取石成功率为87.0%，解除胆道梗阻成功率为90.2%。总共完成了 530 名患者满意度调查，调查结果显示，对于“您愿意让这位医生再次进行手术吗？”这一问题的回答是患者满意度最敏感的指标。结论：在这个社区实践中，并发症发生率与学术中心相比非常有利。技术成功率达到或超过了 ASGE/美国胃肠病学学院工作组推荐的水平。 （胃肠测试 Endosc 2009；70：457-67。）
Background: There are no large Studies documenting quality Outcomes and complication rates of ERCP in community practice. The American Society for Gastrointestinal Endoscopy (ASGE)/American College of Gastroenterology Task Force on Quality proposed 5 questions regarding ERCP in community practice. The ASGE Committee on Outcomes Research recommended 8 ERCP-specific quality indicators be used to provide a better accounting of quality in ERCPObjective: To determine ERCP quality outcomes, including complications, in a community practice.Design: Prospective study Setting: Eight community hospitals in the Minneapolis-St. Paul, Minnesota, area.Patients: Every patient undergoing ERCP by Minnesota Gastroenterology PA from December 1, 2005, through July 31, 2006.Main Outcome Measurements: ASGE-recommended quality indicators, especially 30-day complication rates.Results: A total of 805 ERCP procedures were performed in 696 patients. Therapeutic ERCP accounted for 78.4%. The complication rate was 5.0% (5.7% of therapeutic and 2.3% of diagnostic procedures). Pancreatitis occurred in 3.2% of procedures (3.6% of therapeutic and 1.7% of diagnostic procedures). Infection (0.75%.), hemorrhage (0.62%), and perforation (0.12%) only occurred after therapeutic ERCP Cardiopulmonary complications occurred in 2 patients (0.25%). Precut sphincterotomy was performed in 26 cases (3.2%), and sphincter of Oddi manometry in 23 cases (2.9%). Success rates were 94.0% for biliary cannulation, 87.0% for stone extraction, and 90.2% for relieving biliary obstruction. A total of 530 patient satisfaction surveys were completed and revealed that the response to the question, "Would You have the procedure done again by this physician?" was the most sensitive indicator of patient satisfaction.Conclusions: In this community practice, complication rates compare very favorably with those of academic centers. The technical success rates achieved or exceeded rates recommended by the ASGE/American College of Gastroenterology Task Force. (Gastrointest Endosc 2009;70:457-67.)