Variation in hospital mortality after pancreatoduodenectomy is related to failure to rescue rather than major complications: a nationwide audit.

Autor:	van Rijssen LB; Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands., Zwart MJ; Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands., van Dieren S; Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands., de Rooij T; Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands., Bonsing BA; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Bosscha K; Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands., van Dam RM; Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands., van Eijck CH; Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands., Gerhards MF; Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands., Gerritsen JJ; Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands., van der Harst E; Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands., de Hingh IH; Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands., de Jong KP; Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands., Kazemier G; Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands., Klaase J; Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands., van der Kolk BM; Department of Surgery, Radboud University Medical Center, The Netherlands., van Laarhoven CJ; Department of Surgery, Radboud University Medical Center, The Netherlands., Luyer MD; Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands., Molenaar IQ; Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands., Patijn GA; Department of Surgery, Isala Clinics, Zwolle, The Netherlands., Rupert CG; Department of Surgery, Tjongerschans Hospital, Heerenveen, The Netherlands., Scheepers JJ; Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands., van der Schelling GP; Department of Surgery, Amphia Hospital, Breda, The Netherlands., Vahrmeijer AL; Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands., Busch ORC; Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands., van Santvoort HC; Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands., Groot Koerkamp B; Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands., Besselink MG; Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl.
Jazyk:	angličtina
Zdroj:	HPB : the official journal of the International Hepato Pancreato Biliary Association [HPB (Oxford)] 2018 Aug; Vol. 20 (8), pp. 759-767. Date of Electronic Publication: 2018 Mar 21.
DOI:	10.1016/j.hpb.2018.02.640
Abstrakt:	Background: In the mandatory nationwide Dutch Pancreatic Cancer Audit, rates of major complications and Failure to Rescue (FTR) after pancreatoduodenectomy between low- and high-mortality hospitals are compared, and independent predictors for FTR investigated. Methods: Patients undergoing pancreatoduodenectomy in 2014 and 2015 in The Netherlands were included. Hospitals were divided into quartiles based on mortality rates. The rate of major complications (Clavien-Dindo ≥3) and death after a major complication (FTR) were compared between these quartiles. Independent predictors for FTR were identified by multivariable logistic regression analysis. Results: Out of 1.342 patients, 391 (29%) developed a major complication and in-hospital mortality was 4.2%. FTR occurred in 56 (14.3%) patients. Mortality was 0.9% in the first hospital quartile (4 hospitals, 327 patients) and 8.1% in the fourth quartile (5 hospitals, 310 patients). The rate of major complications increased by 40% (25.7% vs 35.2%) between the first and fourth hospital quartile, whereas the FTR rate increased by 560% (3.6% vs 22.9%). Independent predictors of FTR were male sex (OR = 2.1, 95%CI 1.2-3.9), age >75 years (OR = 4.3, 1.8-10.2), BMI ≥30 (OR = 2.9, 1.3-6.6), histopathological diagnosis of periampullary cancer (OR = 2.0, 1.1-3.7), and hospital volume <30 (OR = 3.9, 1.6-9.6). Conclusions: Variations in mortality between hospitals after pancreatoduodenectomy were explained mainly by differences in FTR, rather than the incidence of major complications. (Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
Databáze:	MEDLINE
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