Clinical impact of developing better practices at the institutional level on surgical outcomes after distal pancreatectomy in 1515 patients: Domestic audit of the Japanese Society of Pancreatic Surgery

被引：4

作者：

Satoi, Sohei ^{[1
]}

Yamamoto, Tomohisa ^{[1
]}

Motoi, Fuyuhiko ^{[2
]}

Matsumoto, Ippei ^{[3
]}

Yoshitomi, Hideyuki ^{[4
]}

Amano, Ryosuke ^{[5
]}

Tahara, Munenori ^{[6
]}

Murakami, Yoshiaki ^{[7
]}

Arimitsu, Hidehito ^{[8
]}

Hirono, Seiko ^{[9
]}

Sho, Masayuki ^{[10
]}

Ryota, Hironori ^{[1
]}

Ohtsuka, Masayuki ^{[4
]}

Unno, Michiaki ^{[2
]}

Takeyama, Yoshifumi ^{[3
]}

Yamaue, Hiroki ^{[9
]}

机构：

[1] Kansai Med Univ, Dept Surg, Hirakata, Osaka, Japan

[2] Tohoku Univ, Grad Sch Med, Dept Surg, Sendai, Miyagi, Japan

[3] Kindai Univ, Fac Med, Dept Surg, Osaka, Japan

[4] Chiba Univ, Grad Sch Med, Dept Gen Surg, Chiba, Japan

[5] Osaka City Univ, Dept Surg Oncol, Osaka, Japan

[6] Sapporo Kosei Hosp, Dept Surg, Sapporo, Hokkaido, Japan

[7] Hiroshima Univ, Inst Biomed & Hlth Sci, Dept Surg, Hiroshima, Japan

[8] Chiba Canc Ctr Hosp, Div Gastroenterol Surg, Chiba, Japan

[9] Wakayama Med Univ, Sch Med, Dept Surg 2, Wakayama, Japan

[10] Nara Med Univ, Dept Surg, Kashihara, Nara, Japan

来源：

ANNALS OF GASTROENTEROLOGICAL SURGERY | 2018年 / 2卷 / 03期

关键词：

distal pancreatectomy; morbidity; mortality; process of care; standardization; INTERNATIONAL STUDY-GROUP; RISK-FACTORS; RESECTION; MORBIDITY; VOLUME; DEFINITION; EXPERIENCE; MORTALITY; REMOVAL; FISTULA;

D O I：

10.1002/ags3.12066

中图分类号：

R57 [消化系及腹部疾病];

学科分类号：

摘要：

Background and Aim: Institutional standardization in the perioperative management of distal pancreatectomy (DP) has not been evaluated in a multicenter setting. The aim of the present study was to assess the influence of institutional standardization on the development of postoperative complications after DP. Methods: Data were collected from 1515 patients who underwent DP in 2006, 2010, and 2014 at 53 institutions in Japan. A standardized institution (SI) was defined as one that implemented >= 6 of 11 quality initiatives according to departmental policy. There were 541 patients in the SI group and 974 in the non-SI group. Clinical parameters were compared between groups. Risk factors for morbidity and mortality were assessed by logistic regression analysis with a mixed-effects model. Results: Proportion of patients who underwent DP in SI increased from 16.5% in 2006 to 46.4% in 2014. The SI group experienced an improved process of care and a lower frequency of severe complications vs the non-SI group (grade III/IV Clavien-Dindo; 22% vs 29%, respectively, clinically relevant postoperative pancreatic fistula; 22% vs 31%, respectively, P < .05 for both). Duration of in-hospital stay in the SI group was significantly shorter than that in the non-SI group (16 [5-183] vs 20 postoperative days [5-204], respectively; P = .002). Multivariate analysis with a mixed-effects model showed that soft pancreas, late drain removal, excess blood loss and long surgical time were risk factors for post-DP complications (P < .05). Pancreatic texture, drain management and surgical factors, but not standardization of care, were associated with a lower incidence of post-DP complications.

引用

页码：212 / 219

页数：8

共 25 条

[21] Developing better practices at the institutional level leads to better outcomes after pancreaticoduodenectomy in 3,378 patients: domestic audit of the Japanese Society of Pancreatic Surgery [J].