Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality
Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality
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DOI：
10.1002/bjs.8664
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发表时间：
2012-03-01
影响因子：
9.6
通讯作者：
Molenaar, I. Q.
中科院分区：
文献类型：
--
作者：
de Wilde, R. F.;Besselink, M. G. H.;Molenaar, I. Q.
背景：在全国范围内集中进行胰腺癌切除术（PD）对死亡率的影响尚不清楚。本研究的目的是分析2004年至2009年荷兰腹膜透析后住院患者数量和住院死亡率的变化。方法：从独立的全国KiwaPrismant登记处检索全国范围内国际疾病分类第九版（ICD-9）编码5-526（PD，包括维普莱）、患者年龄、性别和死亡率的数据。根据每年进行PD的既定截止点，医院被分类为极低（少于5）、低（5-10）、中等（11-19）或高（至少20）量。一个亚组分析的截止年龄为70 years also performed.Results：一些2155 PD被列入。实施腹膜透析的医院数量从2004年的48家减少到2009年的30家（P = 0.011）。在这些特定年份，在中等或高容量中心接受PD的患者比例从52.9%增加到91.2%（P < 0.001）。PD后的全国死亡率从9.8%下降到5.1%（P = 0.044）。在这6年期间，极低、低、中和高流量医院的死亡率分别为14.7%、9.8%、6.3%和3.3%（P < 0.001）。中容量和高容量中心之间的死亡率差异具有统计学意义（P = 0.004）。容量-结局关系不受年龄影响（P = 0.467）。70岁以上患者PD后的死亡率为10.4%，较年轻患者为4.4%（P < 0.001）。结论：随着全国范围内PD的集中，PD后的住院死亡率下降。PD的进一步集中可能会进一步降低死亡率，特别是在老年人中。
Background: The impact of nationwide centralization of pancreaticoduodenectomy (PD) on mortality is largely unknown. The aim of this study was to analyse changes in hospital volumes and in-hospital mortality after PD in the Netherlands between 2004 and 2009.Methods: Nationwide data on International Classification of Diseases, ninth revision (ICD-9) code 5-526 (PD, including Whipple), patient age, sex and mortality were retrieved from the independent nationwide KiwaPrismant registry. Based on established cut-off points of annually performed PDs, hospitals were categorized as very low (fewer than 5), low (5-10), medium (11-19) or high (at least 20) volume. A subgroup analysis based on a cut-off age of 70 years was also performed.Results: Some 2155 PDs were included. The number of hospitals performing PD decreased from 48 in 2004 to 30 in 2009 (P = 0.011). In these specific years, the proportion of patients undergoing PD in a medium-or high-volume centre increased from 52.9 to 91.2 per cent (P < 0.001). Nationwide mortality rates after PD decreased from 9.8 to 5.1 per cent (P = 0.044). The mortality rate during the 6-year period was 14.7, 9.8, 6.3 and 3.3 per cent in very low-, low-, medium-and high-volume hospitals respectively (P < 0.001). The difference in mortality between medium-and high-volume centres was statistically significant (P = 0.004). The volume-outcome relationship was not influenced by age (P = 0.467). The mortality rate after PD in patients aged at least 70 years was 10.4 per cent compared with 4.4 per cent in younger patients (P < 0.001).Conclusion: With nationwide centralization of PD, the in-hospital mortality rate after this procedure decreased. Further centralization of PD is likely to decrease mortality further, especially in the elderly.