胆囊切除术的教科书结果：这一工具对低发病率的干预有用吗？

IF 1.3 4区医学 Q3 SURGERY

Cirugia Espanola Pub Date : 2024-11-01 DOI:10.1016/j.ciresp.2024.05.011

David Hernández-Bermejo , Celia García-Vega , Juan Jesús Rubio-García , Celia Villodre-Tudela , Silvia Carbonell-Morote , José Manuel Ramia

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引用次数: 0

摘要

导言: 胆石症是消化系统最常见的医院诊断，如果有症状，其治疗方法是腹腔镜胆囊切除术。对术后疗效和医疗机构效率进行综合评估的需求日益增长。教科书式疗效"（TO）指的是肿瘤手术中常用的护理质量，通过添加几个术后参数来获得，从而告知是否获得了完美的疗效。本研究的主要目的是确定胆囊切除术的 TO，并了解影响其实现的因素。方法对 2018-2020 年间接受胆囊切除术的患者进行回顾性观察性单中心队列研究。我们将 TO 定义为满足以下前提条件的患者：Clavien-Dindo并发症<III，手术后住院时间少于第75百分位数（<3天），前九十天内无再入院或死亡。我们分析了围手术期的特征，并根据患者是否达到 TO 标准将其分为两组。我们根据手术报告定义了困难胆囊切除术的标准。结果手术成功率为72%（342/475）（择期手术为82.6%，紧急手术为60.5%）。单变量分析表明，以下因素与实现TO相关：女性、63岁、ASA风险III级、择期手术、腹腔镜方法、非困难胆囊切除术。经过多变量分析，ASA< III（OR 2.39 CI95% 1.37-4.16）、择期手术（OR 2.77 CI95% 1.64-4.67）、腹腔镜方法（OR 5.71 CI95% 2.89-11.30）和非困难胆囊切除术（OR 0.42 CI95% 0.结论TO是一种医疗质量工具，操作简单，易于解释，有助于评估医疗质量和比较医疗中心。它不仅适用于肿瘤手术，也适用于胆囊切除术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

Textbook outcome en colecistectomía. ¿Es útil esta herramienta en una intervención con baja tasa de morbilidad?

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Textbook outcome en colecistectomía. ¿Es útil esta herramienta en una intervención con baja tasa de morbilidad?

Introduction

Cholelithiasis is the most common hospital diagnosis of the digestive system, and its treatment, if symptomatic, is laparoscopic cholecystectomy. There is a growing need for comprehensive determination of postoperative outcomes and the efficiency of healthcare facilities. The “textbook outcome”(TO) indicates the quality of care commonly used in oncological procedures, obtained by adding several postoperative parameters, which informs whether a perfect result has been obtained. The main objective of this study is to determine the TO for cholecystectomy and to see the factors that influence its achievement.

Methods

Retrospective observational unicentric cohort study on patients who underwent cholecystectomy between 2018-2020. We defined TO as those patients who met the following premises: Clavien-Dindo complications < III, postsurgical stay less than the 75th percentile (<3 days), and no readmissions or mortality in the first ninety days. Perioperative characteristics were analyzed, and the patients were divided into two groups according to whether or not they achieved TO. We defined criteria for difficult cholecystectomy according to the operative report.

Results

The percentage of TO was 72% (342/475) (82.6% in elective surgery and 60.5% in urgent surgery). The univariate analysis showed that the following factors are associated with achieving TO: female sex, age < 63 years, ASA risk < III, elective surgery, laparoscopic approach, and not difficult cholecystectomy. After multivariate analysis, ASA< III (OR 2.39 CI95% 1.37-4.16), elective surgery (OR 2.77 CI95% 1.64-4.67), laparoscopic approach (OR 5.71 CI95% 2.89-11.30) and not to be difficult cholecystectomy (OR 0.42 CI95% 0.259-0.71) remained statistically significant.

Conclusions

The TO is a healthcare quality tool that is simple to perform, easily interpretable, and helpful for evaluating quality in healthcare and comparing centers. It applies not only to oncological procedures but also to cholecystectomy.

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来源期刊

Cirugia Espanola SURGERY-

CiteScore

1.20

自引率

21.10%

发文量

173

审稿时长

53 days

期刊介绍： Cirugía Española, an official body of the Asociación Española de Cirujanos (Spanish Association of Surgeons), will consider original articles, reviews, editorials, special articles, scientific letters, letters to the editor, and medical images for publication; all of these will be submitted to an anonymous external peer review process. There is also the possibility of accepting book reviews of recent publications related to General and Digestive Surgery.