胰腺坏死早期与延迟坏死切除术:关于再入院、医疗保健使用和院内死亡率的人群队列研究。

Hassam Ali, Faisal Inayat, Vinay Jahagirdar, Fouad Jaber, Arslan Afzal, Pratik Patel, Hamza Tahir, Muhammad Sajeel Anwar, Attiq Ur Rehman, Muhammad Sarfraz, Ahtshamullah Chaudhry, Gul Nawaz, Dushyant Singh Dahiya, Amir H Sohail, Muhammad Aziz
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引用次数: 0

摘要

背景:急性坏死性胰腺炎是一种严重的危及生命的疾病。由于其复杂性和高并发症风险,它给临床医生带来了相当大的挑战。目前已开发出多种微创和开放式坏死切除术。目的:评估胰腺坏死切除术时机对美国胰腺坏死患者的影响:利用 2016-2019 年全国再入院数据库开展了一项全国性回顾性队列研究。研究确定了因胰腺坏死而非选择性入院的患者。根据坏死切除术的时间将参与者分为两组:早期组在 48 小时内接受干预,而延迟组则在 48 小时后接受手术。各种干预技术包括内窥镜、经皮或外科坏死切除术。主要研究结果为30天再入院率、医疗服务使用率和住院患者死亡率:共纳入 1309 名胰腺坏死患者。经过倾向评分匹配后,349 例接受早期坏死切除术的患者与 375 例接受延迟干预的对照组进行了匹配。早期队列的 30 天再入院率为 8.6%,而延迟队列为 4.8%(P = 0.040)。早期坏死切除术的机械通气率(2.9% vs 10.9%,P < 0.001)、脓毒性休克率(8% vs 19.5%,P < 0.001)和院内死亡率(1.1% vs 4.3%,P = 0.01)均较低。早期干预组患者的医疗费用较低,总费用中位数为 52202 美元,而延迟干预组为 147418 美元。早期干预组患者的中位住院时间也相对较短(6 天 vs 16 天,P < 0.001)。坏死组织切除术的时间对30天再入院的风险没有显著影响,危险比为0.56(95%置信区间:0.31-1.02,P = 0.06):我们的研究结果表明,早期进行坏死组织切除术可获得更好的临床疗效并降低医疗成本。结论:我们的研究结果表明,早期坏死组织切除术与更好的临床疗效和更低的医疗费用相关,而延迟干预并不会明显改变 30 天再入院的风险。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Early versus delayed necrosectomy in pancreatic necrosis: A population-based cohort study on readmission, healthcare utilization, and in-hospital mortality.

Background: Acute necrotizing pancreatitis is a severe and life-threatening condition. It poses a considerable challenge for clinicians due to its complex nature and the high risk of complications. Several minimally invasive and open necrosectomy procedures have been developed. Despite advancements in treatment modalities, the optimal timing to perform necrosectomy lacks consensus.

Aim: To evaluate the impact of necrosectomy timing on patients with pancreatic necrosis in the United States.

Methods: A national retrospective cohort study was conducted using the 2016-2019 Nationwide Readmissions Database. Patients with non-elective admissions for pancreatic necrosis were identified. The participants were divided into two groups based on the necrosectomy timing: The early group received intervention within 48 hours, whereas the delayed group underwent the procedure after 48 hours. The various intervention techniques included endoscopic, percutaneous, or surgical necrosectomy. The major outcomes of interest were 30-day readmission rates, healthcare utilization, and inpatient mortality.

Results: A total of 1309 patients with pancreatic necrosis were included. After propensity score matching, 349 cases treated with early necrosectomy were matched to 375 controls who received delayed intervention. The early cohort had a 30-day readmission rate of 8.6% compared to 4.8% in the delayed cohort (P = 0.040). Early necrosectomy had lower rates of mechanical ventilation (2.9% vs 10.9%, P < 0.001), septic shock (8% vs 19.5%, P < 0.001), and in-hospital mortality (1.1% vs 4.3%, P = 0.01). Patients in the early intervention group incurred lower healthcare costs, with median total charges of $52202 compared to $147418 in the delayed group. Participants in the early cohort also had a relatively shorter median length of stay (6 vs 16 days, P < 0.001). The timing of necrosectomy did not significantly influence the risk of 30-day readmission, with a hazard ratio of 0.56 (95% confidence interval: 0.31-1.02, P = 0.06).

Conclusion: Our findings show that early necrosectomy is associated with better clinical outcomes and lower healthcare costs. Delayed intervention does not significantly alter the risk of 30-day readmission.

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