医学
胰瘘
胰腺切除术
远端胰腺切除术
胃排空
多元分析
普通外科
瘘管
外科
回顾性队列研究
观察研究
内科学
切除术
胃
胰腺
作者
C. Villodre,Juan del Río-Martín,Gerardo Blanco‐Fernández,Miguel Cantalejo-Díaz,Fernando Pardo,Silvia Carbonell Morote,Elena Muñoz-Forner,A Carabias,Alba Manuel-Vázquez,Pedro J. Hernández-Rivera,Isabel Jaén-Torrejimeno,Helga K. Kälviäinen-Mejía,Fernando Rotellar,Marina Garcés-Albir,Raquel Latorre Fragua,Texell Longoria-Dubocq,Noelia De-Armas-Conde,Alejandro Serrablo,Sara Esteban Gordillo,Lidia Sabater,Mario Serradilla-Martín,José Manuel Ramia Ángel
出处
期刊:Surgery
[Elsevier]
日期:2023-12-01
标识
DOI:10.1016/j.surg.2023.11.012
摘要
Background Textbook outcome is an interesting quality metrics tool. Information on textbook outcomes in distal pancreatectomy is very scarce. In this study we determined textbook outcome in a distal pancreatectomy multicenter database and propose a specific definition of textbook outcome-distal pancreatectomy that includes pancreatic fistula. Methods Retrospective multicenter observational study of distal pancreatectomy performed at 8 hepatopancreatobiliary surgery units from January 1, 2008, to December 31, 2018. The inclusion criteria were any scheduled distal pancreatectomy performed for any diagnosis and age > 18 years. Specific textbook outcome-distal pancreatectomy was defined as hospital stay P < 75, no Clavien–Dindo complications (≥ III), no hospital mortality, and no readmission recorded at 90 days, and the absence of pancreatic fistula (B/C). Results Of the 450 patients included, 262 (58.2%) obtained textbook outcomes. Prolonged stay was the parameter most frequently associated with failure to achieve textbook outcomes. The textbook outcome group presented the following results. Preoperative: lower American Society of Anesthesiologists score < III, a lower percentage of smokers, and less frequent tumor invasion of neighboring organs or vascular invasion; operative: major laparoscopic approach, and less resection of neighboring organs and less operative transfusion; postoperative: lower percentage of delayed gastric emptying and pancreatic fistula B/C, and diagnosis other an adenocarcinoma. In the multivariate study, the American Society of Anesthesiologists score > II, resection of neighboring organs, B/C pancreatic fistula, and delayed gastric emptying were associated with failure to achieve textbook outcomes. Conclusion The textbook outcome rate in our 450 pancreaticoduodenectomies was 58.2%. In the multivariate analysis, the causes of failure to achieve textbook outcomes were American Society of Anesthesiologists score > II, resection of neighboring organs, pancreatic fistula B/C, and delayed gastric emptying. We believe that pancreatic fistula should be added to the specific definition of textbook outcome–distal pancreatectomy because it is the most frequent complication of this procedure.