背景:外科胰腺坏死切除术(SPN)是治疗感染性胰腺坏死的一种选择。文献表明,不断升级,联合内镜,介入放射学和微创手术“阶梯式”方法,如视频辅助腹膜后清创术,可以减少所需的SPN和ICU并发症的数量,如多器官衰竭。我们假设在采用“加强”方法期间,手术治疗的严重坏死性胰腺炎患者的并发症减少。
方法:美国外科医生学会国家外科质量改进计划数据库(ACS-NSQIP)用于在ACS-NSQIP提交医院中查找2007年至2019年的SPN病例。收集死亡率和Clavien-Dindo4级(CD4)ICU并发症。通过单变量和多变量分析确定结果的预测因子。
结果:有2457例SPN。在NSQIP手术病例中,SPN病例从2007年的0.09%下降到2019年的0.01%(p<0.001)。总死亡率为8.5%,不随时间降低。CD4并发症从40%降至27%(p<0.001)。需要返回手术室的SPN病例减少了65%。并发症的多因素预测因素是急诊普外科手术(EGS,p<0.001),血清白蛋白(p<0.0001)和改良的虚弱指数(mFI)(p<0.0001)。死亡率的多变量预测因子是EGS(p<0.0001),血清白蛋白(p<0.0001),和mFI(p<0.04)。2010年后mFI下降(p<0.001)。
结论:SPNs在2010年后下降,CD4并发症减少,降低再次手术率和稳定的死亡率,可能表明广泛采用“逐步升级”方法。较大,有必要进行前瞻性研究,以比较“加强”与开放SPN的适应症和结局.
BACKGROUND: Surgical pancreatic necrosectomy (SPN) is an option for the management of infected pancreatic necrosis. The literature indicates that an escalating, combined endoscopic, interventional radiology and minimally invasive surgery \"step-up\" approach, such as video-assisted retroperitoneal debridement, may reduce the number of required SPNs and ICU complications, such as multiple organ failure. We hypothesized that complications for surgically treated severe necrotizing pancreatitis patients decreased during the period of adoption of the \"step-up\" approach.
METHODS: The American college of surgeons national surgery quality improvement program database (ACS-NSQIP) was used to find SPN cases from 2007 to 2019 in ACS-NSQIP submitting hospitals. Mortality and Clavien-Dindo class 4 (CD4) ICU complications were collected. Predictors of outcomes were identified by univariate and multivariate analyses.
RESULTS: There were 2457 SPN cases. SPN cases decreased from 0.09% in 2007 to 0.01% in 2019 of NSQIP operative cases (p < 0.001). Overall mortality was 8.5% and did not decrease with time. CD4 complications decreased from 40 to 27% (p < 0.001). There was a 65% reduction in SPN cases requiring a return to the operating room. Multivariate predictors of complications were emergency general surgery (EGS, p < 0.001), serum albumin (p < 0.0001) and modified frailty index (mFI) (p < 0.0001). Multivariate predictors of mortality were EGS (p < 0.0001), serum albumin (p < 0.0001), and mFI (p < 0.04). The mFI decreased after 2010 (p < 0.001).
CONCLUSIONS: SPNs decreased after 2010, with decreasing CD4 complications, decreasing reoperation rates and stable mortality rates, likely indicating broad adoption of a \"step-up\" approach. Larger, prospective studies to compare indications and outcomes for \"step up\" versus open SPN are warranted.