Trends in Hospital Volume and Failure to Rescue for Pancreatic Surgery
Trends in Hospital Volume and Failure to Rescue for Pancreatic Surgery
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DOI：
10.1007/s11605-015-2800-9
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发表时间：
2015-09-01
影响因子：
3.2
通讯作者：
Pawlik, Timothy M.
中科院分区：
文献类型：
--
作者：
Amini, Neda;Spolverato, Gaya;Pawlik, Timothy M.
我们试图评估选择高容量（HV）医院进行胰腺手术的趋势，以及术前并发症、死亡率和抢救失败（FTR）的趋势。2000年至2011年间接受胰腺切除术的患者来自全国住院患者样本（NIS）。术前发病率、死亡率和FTR随时间推移进行检查。根据每个时间段每年胰腺切除术的数量将医院容量分层。采用Logistic回归模型评估医院容量对并发症风险、术后死亡率和FTR的影响。共有35,986名患者被确定。医院数量中位数从2000-2003年的13例增加到2008-2011年的55例（P < 0.001）。低容量（LV）、中容量（IV）和HV医院的发病率随时间变化相对相同（P < 0.05）。术后总死亡率为5%，随着时间的推移，所有医院的死亡率都在下降（P < 0.05）。与HV医院（6.4%）相比，FTR在LV（12.0%）和IV（8.5%）容量医院更为常见。与hiv医院相比，LV和IV医院的FTR随时间的改善最为明显（P = 0.001）。在过去的十年中，胰腺手术的中位数医院容量有所增加。虽然随着时间的推移，发病率保持相对稳定，但死亡率有所提高，特别是在左室和四室医院。这种死亡率的改善似乎与FTR的降低有关。
We sought to evaluate trends in selection of high volume (HV) hospitals for pancreatic surgery, as well as examine trends in preoperative complications, mortality, and failure to rescue (FTR).Patients who underwent pancreatic resection between 2000 and 2011 were identified from the Nationwide Inpatient Sample (NIS). Preoperative morbidity, mortality, and FTR were examined over time. Hospital volume was stratified into tertiles based on the number of pancreatic resections per year for each time period. Logistic regression models were used to assess the effect of hospital volume on risk of complication, postoperative mortality, and FTR over time.A total of 35,986 patients were identified. Median hospital volume increased from 13 in 2000-2003 to 55 procedures/year in 2008-2011 (P < 0.001). Morbidity remained relatively the same over time at low volume (LV), intermediate volume (IV), and HV hospitals (all P > 0.05). Overall postoperative mortality was 5 %, and it decreased over time across all hospital volumes (P < 0.05). FTR was more common at LV (12.0 %) and IV (8.5 %) volume hospitals compared with HV hospitals (6.4 %). The improvement in FTR over time was most pronounced at LV and IV hospitals versus HV hospitals (P = 0.001).Median hospital volume for pancreatic surgery has increased over the past decade. While the morbidity remained relatively stable over time, mortality improved especially in LV and IV hospitals. This improvement in mortality seems to be related to a decreased FTR.