将教科书结果作为肝胆胰外科手术的质量指标：系统回顾与元分析》。

IF 2.2 3区医学 Q3 GASTROENTEROLOGY & HEPATOLOGY

Journal of Gastrointestinal Surgery Pub Date : 2025-02-27 DOI:10.1016/j.gassur.2025.102005

Zaiba Shafik Dawood , Mujtaba Khalil , Usama Waqar , Illiyun Banani , Zayan Alidina , Timothy M. Pawlik

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引用次数: 0

摘要

背景：教科书结果（TO）代表了手术后的最佳疗程。迄今为止，还没有荟萃分析评估过接受肝胆胰（HPB）手术的患者的综合疗效以及疗效对患者预后的影响。我们试图进行一项系统性回顾和荟萃分析，以评估不同研究的TO成就，并描述TO成就对患者相关预后（包括无病生存期（DFS）和总生存期（OS））的影响方法：检索了PubMed、Embase和Scopus数据库（1990-2024年）。获得了用于定义TO的标准以及HPB手术中总体TO的中位数。此外，还进行了随机效应荟萃分析，以评估TO成就对5年OS和DFS的影响：72项研究（517304名患者）符合纳入标准。定义TO的主要标准包括出院后30天内无再入院和死亡；严重术后并发症；住院时间延长和手术切缘阴性（R0）。值得注意的是，患者年龄较小和美国麻醉医师协会评分较低是影响手术成功率的主要因素。总体而言，各种手术的中位TO率分别为肝脏-62.0%（IQR:48.0%-69.0%）、胆道-54.0%（IQR:41.0%-68.0%）、肝胆胰联合-46.0%（IQR：42.0%-46.5%）、胰腺- 45.0%（IQR：30.5%-59.0%）、肝移植-33.0%（IQR：32.2%-34.0%）和肝胆联合-19.5%（IQR：16.8%-22.3%）。获得 TO 与 5 年 OS 和 DFS 的几率提高有关（OR：分别为 1.22（95% CI：1.20-1.24）和 1.26（95% CI：1.16-1.37））：总体而言，肝胆手术的TO值最高，其次是胰腺手术。结论：总体而言，肝胆手术的TO值最高，其次是胰腺手术，而肝胆手术和肝移植的TO值最低。不同研究对TO的定义存在明显差异，这凸显了对TO定义达成共识的必要性。

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Use of textbook outcome as a quality metric in hepatopancreaticobiliary surgery: a systematic review and meta-analysis

Background

Textbook outcomes (TOs) represent the optimal course after surgery. To date, no meta-analysis has assessed the pooled TOs of patients undergoing hepatopancreatobiliary (HPB) surgery and the effect of TO achievement on patient outcomes. This systematic review and meta-analysis aimed to assess TO achievement across different studies and to characterize the effect of TO achievement on patient-related outcomes, including disease-free survival (DFS) and overall survival (OS).

Methods

PubMed, Embase, and Scopus databases were searched (1990–2024). The criteria used to define TO and the median overall TO in HPB surgery were obtained. In addition, a random-effects meta-analysis was conducted to assess the effect of TO achievement on 5-year OS and DFS.

Results

A total of 27 studies involving 517,304 patients met inclusion criteria. The main criteria used to define TO included absence of readmission and mortality within 30 days after discharge, severe postoperative complications, prolonged hospital stay, and negative surgical margin (R0). Of note, the main factors related to TO achievement were younger patient age and lower American Society of Anesthesiologists score. Overall, the median rates of TOs achieved across procedures were 62.0% (IQR, 48.0%−69.0%) for hepatic procedure, 54.0% (IQR, 41.0%−68.0%) for biliary procedure, 46.0% (IQR, 42.0%−46.5%) for combined hepatopancreatic procedure, 45.0% (IQR, 30.5%−59.0%) for pancreatic procedure, 33.0% (IQR, 32.2%−34.0%) for liver transplantation, and 19.5% (IQR, 16.8%−22.3%) for combined hepatobiliary procedure. TO achievement was associated with improved odds of 5-year OS (odds ratio [OR], 1.22 [95% CI, 1.20–1.24]) and 5-year DFS (OR, 1.26 [95% CI, 1.16–1.37]).

Conclusion

Overall, hepatic and biliary operations had the highest TO achievement, followed by pancreatic procedures. In contrast, hepatobiliary surgery and liver transplantation had the lowest TO. There was a significant discrepancy in the definition of TO across different studies, highlighting the need for consensus on the definition of TO.

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来源期刊

Journal of Gastrointestinal Surgery 医学-外科

CiteScore

5.50

自引率

3.10%

发文量

319

审稿时长

2 months

期刊介绍： The Journal of Gastrointestinal Surgery is a scholarly, peer-reviewed journal that updates the surgeon on the latest developments in gastrointestinal surgery. The journal includes original articles on surgery of the digestive tract; gastrointestinal images; "How I Do It" articles, subject reviews, book reports, editorial columns, the SSAT Presidential Address, articles by a guest orator, symposia, letters, results of conferences and more. This is the official publication of the Society for Surgery of the Alimentary Tract. The journal functions as an outstanding forum for continuing education in surgery and diseases of the gastrointestinal tract.