全国性队列胰腺切除术后死亡率的根本原因分析。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2025-04-01 DOI:10.1016/j.hpb.2024.11.014

Anne Claire Henry , F. Jasmijn Smits , Lois A. Daamen , Olivier R. Busch , Koop Bosscha , Ronald M. van Dam , Coen J.L. van Dam , Casper H. van Eijck , Sebastiaan Festen , Erwin van der Harst , Ignace H.J.T. de Hingh , Geert Kazemier , Mike S. Liem , Vincent E. de Meijer , Peter Noordzij , Gijs A. Patijn , Jennifer M.J. Schreinemakers , Martijn W.J. Stommel , Bert A. Bonsing , Bas G. Koerkamp , I. Quintus Molenaar

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引用次数: 0

摘要

背景：本研究评估了全国范围内胰腺切除术后住院死亡率的主要原因，以确定需要改进的领域。方法：本观察性队列研究纳入了荷兰（2014-2019）胰腺切除术后的所有住院死亡率。每次死亡都被认为是由局部并发症（即与手术直接相关，位于手术区域）或全身并发症（例如心脏或肺部）引起的。一个盲法专家委员会审查了导致死亡的术后过程，并确定了潜在的质量改进措施。结果：5345例行胰腺切除术的患者中，149例（2.8%）在医院死亡。局部并发症导致126例（85%）患者死亡，全身并发症导致23例（15%）患者死亡。至于局部并发症，常见的主要死亡原因是术后胰瘘（n = 41）和血管重建血栓形成（n = 23）。全身心脏（n = 8）和肺部（n = 7）并发症经常导致死亡。可能改进的领域是抢救失败(n = 89；60%)，预防并发症（n = 34, 23%）和患者选择(n = 14；9%)。结论：局部并发症是胰腺切除术后死亡的主要原因，以胰瘘和血管重建失败为主。抢救失败被认为是进一步降低住院死亡率最重要的改进领域。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Root-cause analysis of mortality after pancreatic resection in a nationwide cohort

Background

This study evaluates leading causes of in-hospital mortality after pancreatic resection nationwide to determine areas for improvement.

Methods

This observational cohort study included all in-hospital mortality after pancreatic resection in the Netherlands (2014–2019). Each fatality was considered to be caused by local complications (i.e. directly related to surgery, located in surgical area) or systemic complications (e.g. cardiac or pulmonary). A blinded Expert Committee reviewed the postoperative course leading to death and identified potential quality improvement measures.

Results

Out of 5345 patients undergoing pancreatic resection, 149 patients (2.8 %) died in-hospital. Local complications caused death in 126 patients (85 %) and systemic complications in 23 patients (15 %). Concerning local complications, the common leading causes of death were postoperative pancreatic fistula (n = 41) and thrombosis of vascular reconstructions (n = 23). Systemic cardiac (n = 8) and pulmonary (n = 7) complications caused death frequently. Potential areas for improvement were failure to rescue (n = 89; 60 %), prevention of complications (n = 34, 23 %) and patient selection (n = 14; 9 %).

Conclusion

Local complications often caused death after pancreatic resection, mainly pancreatic fistula and vascular reconstruction failure. Failure to rescue was considered the most important area for improvement to decrease in-hospital mortality further.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).