背景:胰腺癌通过经皮活检(PB)进行组织学诊断,内镜活检(EB),或手术活检(SB)。与方法类型相关的因素和结果尚不清楚。我们的目的是评估保险地位之间的关系,住院时间(LOS),并发症,和不同的胰腺活检方式。
方法:从国家(全国)住院患者样本(NIS)的2001-2013年数据库中查询了使用国际疾病分类进行活检的胰腺癌患者,第九次修订(ICD-9)代码。有关保险状况的数据,住院,人口统计,采用卡方和多变量分析,α<0.001。
结果:共有824,162例胰腺癌患者被确认。与SB相比,无保险和医疗补助患者更有可能获得PB。与SB相比,EB患者更容易出现急性肾功能衰竭(ARF)。与SB相比,EB或PB患者更有可能发生尿路感染(UTI)。所有活检类型都不太可能发生肺炎;与PB和SB相比,EB中的胰腺炎更为普遍。
结论:与EB相比,无保险和医疗补助患者最有可能患有PB,尽管适应症不明确,这可能代表医疗保健利用的潜在差异。EB患者的LOS最短,而SB患者再停留三天;接受活检组合的患者的LOS最大。EB患者更容易发生ARF,UTI,和胰腺炎比SB,可能归因于超声内镜的先进性。重要的是建立适当的算法贡献者来指导决策。
BACKGROUND: Pancreatic cancer is diagnosed histologically through percutaneous biopsy (PB), endoscopic biopsy (EB), or surgical biopsy (SB). Factors and outcomes associated with method type are not clearly understood. We aimed to evaluate the relationship between insurance status, length of hospital stay (LOS), complications, and different pancreatic biopsy modalities.
METHODS: The 2001-2013 database from the National (Nationwide) Inpatient Sample (NIS) was queried for those with pancreatic cancer who underwent biopsies using International Classification of Diseases, Ninth Revision (ICD-9) codes. Data regarding insurance status, hospital stay, demographics, and complications were analyzed using chi-square and multivariate analysis with α < 0.001.
RESULTS: A total of 824,162 patients with pancreatic cancer were identified. Uninsured and Medicaid patients were more likely to get PB compared to SB. Patients were more likely to have acute renal failure (ARF) with an EB compared to SB. Patients were more likely to have a urinary tract infection (UTI) with EB or PB compared to SB. All biopsy types were less likely to have pneumonia; pancreatitis was more prevalent in EB compared to PB and SB.
CONCLUSIONS: Uninsured and Medicaid patients were most likely to have a PB compared to EB despite unclear indications which may represent an underlying discrepancy in healthcare utilization. EB patients had the shortest LOS while SB patients stayed three more days; those who underwent a combination of biopsies had the greatest LOS. Patients with EB were more likely to develop ARF, UTI, and pancreatitis than SB, possibly attributed to the advanced nature of endoscopic ultrasound. It is important to establish appropriate algorithm contributors to guide decision-making.