IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.09.012

Faruk Koca , Ekaterina Petrova , Hanan El Youzouri, Jan Heil, Michael Heise, Svenja Sliwinski, Wolf O. Bechstein, Andreas A. Schnitzbauer

Background

The impact of resection margin and lymph node status on survival in patients undergoing resection for perihilar cholangiocarcinoma (pCCA) is controversial. The aim of this study was to investigate the influence of nodal and resection margin status on long-term survival after resection for pCCA.

Methods

Retrospective analysis of patients resected for pCCA at the University Hospital Frankfurt, Germany between 1999 and 2022. The patients were categorized in four groups according to resection margin (R) and nodal status (N). Survival was analyzed with univariable and multivariable Cox regression.

Results

Out of 123 patients, 100 with long-term survival were included in the survival analysis. In the univariable analysis, negative resection margin (p = 0.02) and lower grade (p = 0.004) were the only significant positive prognostic factors, while the difference between N0 and N+ was not statistically significant (p = 0.062). Median survival in the groups R0N0, R0N+, R + N0 and R+N+ groups was 40.1, 29.9, 18.4 and 18.9 months, respectively (p = 0.03). In the multivariable analysis, after adjusting for grade, nodal and resection margin status, only grade and resection margin had prognostic significance.

Conclusion

Patients with negative resection margin after resection for pCCA have a better prognosis, regardless of the presence of lymph node metastases.

背景：切除边缘和淋巴结状态对接受肝周胆管癌（pCCA）切除术患者生存率的影响存在争议。本研究旨在探讨结节和切除边缘状态对pCCA切除术后长期生存的影响：方法：对 1999 年至 2022 年期间在德国法兰克福大学医院接受 pCCA 切除术的患者进行回顾性分析。根据切除边缘（R）和结节状态（N）将患者分为四组。采用单变量和多变量考克斯回归法分析了患者的生存率：结果：在123名患者中，有100名长期存活者被纳入生存分析。在单变量分析中，阴性切除边缘（p = 0.02）和较低分级（p = 0.004）是唯一显著的阳性预后因素，而 N0 和 N+ 之间的差异无统计学意义（p = 0.062）。R0N0组、R0N+组、R + N0组和R+N+组的中位生存期分别为40.1个月、29.9个月、18.4个月和18.9个月（p = 0.03）。在多变量分析中，调整分级、结节和切除边缘状态后，只有分级和切除边缘具有预后意义：结论：无论是否存在淋巴结转移，pCCA切除术后切除缘阴性的患者预后较好。

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引用次数: 0

The impact of chronic obstructive pulmonary disease on risk for complications after pancreatoduodenectomy - a single centre cohort study 慢性阻塞性肺病对胰十二指肠切除术后并发症风险的影响--一项单中心队列研究。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.10.005

Patrik Larsson , Oskar Swartling , Giampaolo Perri , Kaveh Vaez , Marcus Holmberg , Fredrik Klevebro , Stefan Gilg , Ernesto Sparrelid , Poya Ghorbani

Background

The association between chronic obstructive pulmonary disease (COPD) and risk for postoperative complications after pancreatic surgery has not been clarified. The aim of this study was to investigate if COPD is associated with increased risk for postoperative complications after pancreatoduodenectomy.

Methods

All patients aged ≥18 years undergoing pancreatoduodenectomy from 2008 to 2019 at a high-volume tertiary centre for pancreatic cancer surgery were included. COPD was defined as an established diagnosis according to the International Statistical Classification of Diseases. The primary outcome was Clavien-Dindo-score (CD)≥ IIIa.

Results

Out of 1009 available patients, 57 (5.6 %) had a diagnosis of COPD. There was no association between COPD and CD≥ IIIa (25.5 % vs. 29.8 % p-value 0.471). COPD was associated with an increased risk for postoperative pancreatic fistula (POPF) (odds ratio [OR] 3.06, 95 % confidence interval 1.62–5.89; p < 0.001). The 12 months mortality rate was higher among patients with COPD compared to patients without COPD, although not statistically significant (28.07 % vs., 18.17 %, p-value = 0.063).

Conclusion

COPD was associated with increased risk for POPF. These results imply that among patients deemed fit enough to undergo surgery, COPD should be thoroughly evaluated in the risk stratification.

背景：慢性阻塞性肺疾病（COPD）与胰腺手术后并发症风险之间的关系尚未明确。本研究旨在探讨慢性阻塞性肺病是否与胰十二指肠切除术后并发症风险增加有关：方法：纳入2008年至2019年期间在一家胰腺癌手术量较大的三级中心接受胰十二指肠切除术的所有年龄≥18岁的患者。根据《国际疾病统计分类》，慢性阻塞性肺病被定义为已确诊的疾病。主要结果为Clavien-Dindo评分（CD）≥ IIIa：在 1009 名患者中，有 57 人（5.6%）被诊断为慢性阻塞性肺病。慢性阻塞性肺病与 CD≥ IIIa 之间没有关联（25.5% 对 29.8%，P 值 0.471）。慢性阻塞性肺病与术后胰瘘 (POPF) 的风险增加有关（几率比 [OR] 3.06，95% 置信区间 1.62-5.89；P 结论：慢性阻塞性肺病与术后胰瘘的风险增加有关：慢性阻塞性肺病与 POPF 风险增加有关。这些结果表明，在被认为适合接受手术的患者中，在进行风险分层时应全面评估慢性阻塞性肺病。

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引用次数: 0

Open versus minimally invasive hepatic and pancreatic surgery: 1-year costs, healthcare utilization and days of work lost 开放式与微创肝脏和胰腺手术：1年成本、医疗保健利用率和误工天数。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.10.017

Muhammad M.M. Khan, Selamawit Woldesenbet, Muhammad M. Munir, Mujtaba Khalil, Yutaka Endo, Erryk Katayama, Diamantis Tsilimigras, Zayed Rashid, Abdullah Altaf, Timothy M. Pawlik

Background

Utilization of minimally invasive surgery (MIS) has become increasingly popular due to its potential benefits such as earlier recovery and reduced morbidity. We sought to characterize differences in 1-year healthcare costs and missed workdays among patients undergoing MIS and open surgery for a hepatic or pancreatic indication.

Methods

Data on patients who underwent hepatic and pancreatic resection were obtained from the IBM Marketscan database. Generalized linear models were utilized to compare healthcare costs and missed workdays among patients undergoing MIS versus open surgery.

Results

Among 8705 patients, 85.0 % (n = 7399) and 15.0 % (n = 1306) of patients underwent an open or MIS HP procedure, respectively. In the unmatched cohort, patients who underwent MIS were more likely to be female (62.7 % vs. 54.6 %) and were less likely to have a Charlson Comorbidity Index score >2 (34.5 % vs. 49.6 %) (both p < 0.05). After entropy balancing, multivariable analysis demonstrated that MIS was associated with lower 1-year post discharge expenditures (mean difference -$9,739, 95%CI-$12,893, -$6585) and fewer missed workdays at 1-year post-discharge (IRR 0.84, 95%CI 0.81–0.87) (all p < 0.001).

Conclusion

At index hospitalization and 1-year post-discharge, an HP MIS approach was associated with lower healthcare expenditures versus open surgery for hepatic and pancreatic resection, as well as fewer missed workdays.

背景：由于微创手术（MIS）具有提前康复和降低发病率等潜在优势，因此越来越受到人们的青睐。我们试图描述因肝脏或胰腺适应症而接受微创手术和开放手术的患者在 1 年医疗费用和误工天数方面的差异：方法：我们从 IBM Marketscan 数据库中获取了接受肝脏和胰腺切除术的患者数据。利用广义线性模型比较了接受 MIS 与开放手术患者的医疗费用和误工天数：在8705名患者中，分别有85.0%（n = 7399）和15.0%（n = 1306）的患者接受了开放式或MIS HP手术。在非配对队列中，接受 MIS 手术的患者中女性比例更高（62.7% 对 54.6%），Charlson 综合征指数评分大于 2 分的比例更低（34.5% 对 49.6%）（均为 p 结论：接受 MIS 手术的患者中女性比例更高（62.7% 对 54.6%），Charlson 综合征指数评分大于 2 分的比例更低（34.5% 对 49.6%）：在指数住院和出院 1 年后，采用 HP MIS 方法进行肝脏和胰腺切除术与开放手术相比，医疗支出更低，误工天数更少。

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引用次数: 0

Robotic versus open pancreaticoduodenectomy in octogenarians: a comparative propensity score analysis of perioperative outcomes 八旬老人的机器人胰十二指肠切除术与开腹胰十二指肠切除术：围手术期结果的倾向评分比较分析。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.10.004

Andres A. Abreu, Amr I. Al Abbas, Jennie Meier, Ricardo E. Nunez-Rocha, Emile Farah, Cecilia G. Ethun, Matthew R. Porembka, John C. Mansour, Adam C. Yopp, Herbert J. Zeh III, Sam C. Wang, Patricio M. Polanco

Background

Compared to open pancreaticoduodenectomies (OPD), the robotic (RPD) approach decreases the rate of complication and the length of stay (LOS). However, it remains unknown if these benefits persist in octogenarians, who are at higher risk for perioperative morbidity and mortality.

Methods

A retrospective analysis of the ACS-NSQIP database was performed to identify patients aged 80 years or older who underwent PD for pancreatic adenocarcinoma between 2015–2021. Patients who underwent RPD or OPD were compared using inversed probability weighting of the propensity score. Outcomes assessed include operative time, LOS, non-home discharge, major complications, unplanned readmission, return to the operating room, mortality, and clinically relevant postoperative pancreatic fistula.

Results

Of 30,751 patients, 1720 were octogenarians. One thousand six hundred twenty-five patients (94 %) underwent OPD, and 95 (6 %) underwent RPD. RPD was significantly associated with a reduced incidence of major complications (32.6 % vs. 45.6 %; p < 0.01) and a lower rate of non-home discharge (24.7 % vs. 34.3%; p < 0.05). However, RPD was associated with a longer operative time (438 min vs. 342 min; p < 0.0001). There was no difference in other assessed outcomes.

Conclusion

RPD may reduce major postoperative complications and non-home discharges compared to the open approach for octogenarians.

背景：与开腹胰十二指肠切除术（OPD）相比，机器人胰十二指肠切除术（RPD）可降低并发症发生率，缩短住院时间（LOS）。然而，对于围手术期发病率和死亡率风险较高的八旬老人来说，这些优势是否依然存在仍是未知数：对 ACS-NSQIP 数据库进行回顾性分析，以确定在 2015-2021 年间接受胰腺腺癌手术的 80 岁或以上患者。采用反概率加权倾向评分对接受 RPD 或 OPD 的患者进行比较。评估的结果包括手术时间、LOS、非居家出院、主要并发症、非计划再入院、返回手术室、死亡率和临床相关的术后胰瘘：在 30751 名患者中，有 1720 名八旬老人。1625名患者（94%）接受了手术治疗，95名患者（6%）接受了RPD治疗。RPD明显降低了主要并发症的发生率（32.6% 对 45.6%；P < 0.01），降低了非居家出院率（24.7% 对 34.3%；P < 0.05）。不过，RPD的手术时间更长（438 分钟对 342 分钟；P < 0.0001）。其他评估结果没有差异：结论：与开腹手术相比，RPD可减少八旬老人术后的主要并发症和非居家出院。

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引用次数: 0

Replacement of the main bile duct by bioprosthesis in an experimental porcine model (24-month results) 在实验猪模型中用生物假体置换主胆管（24 个月的结果）。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.10.009

Eduardo E. Montalvo-Javé , Benjamín León-Mancilla , Mariana Espejel-Deloiza , Jonathan Chernizky , Alan Valderrama-Treviño , María C. Piña-Barba , César Montalvo-Arenas , Carlos Gutiérrez-Banda , Rita Dorantes-Heredia , Natalia Nuño-Lámbarri

Background

Cholecystectomy for conditions like iatrogenic injury during cholecystectomy can lead to complications such as bile duct injuries, necessitating alternative options like bioprosthesis.

Methods

This study evaluated a bioprosthesis’s efficacy in maintaining bile duct continuity over 24 months in 16 male pigs.

Results

The bioprosthesis was implanted in the common bile duct of three-month-old animals, with follow-ups at 1, 6, 12, 18, and 24 months. Liver function remained stable, and biliary permeability was assessed through various imaging techniques. Despite mild stenosis, biliary flow was unimpeded. Histological analysis confirmed biliary epithelium presence in the regenerated area.

Conclusion

The bioprosthesis acted as a scaffold for tissue regeneration without compromising biliary function. Remnants of the bioprosthesis were observed but did not affect biliary excretion in the 24-month porcine model. This study highlights the bioprosthesis’s potential in bile duct reconstruction, offering a safe and effective option for maintaining biliary continuity.

背景：胆囊切除术中的先天性损伤等情况会导致胆管损伤等并发症，因此需要生物假体等替代方案：本研究评估了生物假体在16头雄性猪体内维持胆管连续性24个月的效果：结果：将生物假体植入三个月大的动物的胆总管，并在 1、6、12、18 和 24 个月时进行随访。肝功能保持稳定，胆道通透性通过各种成像技术进行了评估。尽管胆管轻度狭窄，但胆汁流动畅通无阻。组织学分析证实，再生区域存在胆道上皮：结论：生物假体是组织再生的支架，不会影响胆道功能。在为期 24 个月的猪模型中，观察到了生物假体的残留物，但不会影响胆汁排泄。这项研究强调了生物假体在胆管重建中的潜力，为保持胆道连续性提供了一种安全有效的选择。

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引用次数: 0

Pancreatic surgery after preoperative biliary drainage in periampullary cancers: does timing matter? A systematic review and meta-analysis 胰周癌患者术前胆道引流后进行胰腺手术：时机是否重要？系统回顾和荟萃分析。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.10.001

Mohamed Maatouk , Ghassen H. Kbir , Anis Ben Dhaou , Mariem Nouira , Atef Chamekh , Sami daldoul , Sofien Sayari , Mounir Ben Moussa

Background

Preoperative biliary drainage (PBD) has been introduced to control the negative effects of obstructive jaundice in patients undergoing pancreaticoduodenectomy (PD). The optimal time interval between PBD and PD remains unclear. The purpose of our systematic review and meta-analysis was to evaluate the optimal period for PBD before PD.

Methods

Studies were searched in PubMed, Science Direct, Google Scholar and Cochrane Library until 30 March 2024. Studies using PBD in patients with malignant obstructive jaundice that compared the short duration group (SDG) with prolonged duration group (PDG) were included in this study. The definitions of short and prolonged drainage were based on cut-off times reported in the included studies.

Results

Twelve studies were included. Based on the available data, short and prolonged drainage periods were defined by comparing the outcomes of surgeries performed within specific cut-off times of 2 weeks, 3 weeks, and 4 weeks after PBD. No significant differences were observed between the SDG and PDG in mortality, major morbidity, pancreatic fistula, post pancreatectomy haemorrhage, septic complications, operative time, and hospital stay, regardless of the delay of surgery.

Conclusion

When PBD is needed, pancreatic resection could be performed at the earliest possible stage after achieving optimal perioperative care.

背景：术前胆道引流术（PBD）是为了控制胰十二指肠切除术（PD）患者阻塞性黄疸的负面影响。PBD 和 PD 之间的最佳时间间隔仍不明确。我们的系统综述和荟萃分析旨在评估胰十二指肠切除术前进行胰十二指肠切除术的最佳时间间隔：在 PubMed、Science Direct、Google Scholar 和 Cochrane Library 中检索了截至 2024 年 3 月 30 日的研究。本研究纳入了在恶性阻塞性黄疸患者中使用 PBD 的研究，这些研究对短时间组（SDG）和长时间组（PDG）进行了比较。短时间引流和长时间引流的定义基于纳入研究中报告的截止时间：结果：共纳入 12 项研究。根据现有数据，通过比较在 PBD 后 2 周、3 周和 4 周的特定截断时间内进行手术的结果来定义引流时间短和引流时间长。在死亡率、主要发病率、胰瘘、胰腺切除术后出血、化脓性并发症、手术时间和住院时间方面，SDG 和 PDG 之间没有观察到明显差异，无论手术延迟与否：结论：当需要进行胰十二指肠切除术时，可在实现最佳围手术期护理后尽早进行胰腺切除术。

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引用次数: 0

Achievement of international benchmark outcomes for robotic pancreaticoduodenectomy in a low volume country 在一个低产量国家实现机器人胰十二指肠切除术的国际基准成果。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.10.003

Joel Lewin , Mehan Siriwardhane , Shinn Yeung

Background

Recently, there has been an increase in the utilisation of the robotic platform to perform minimally invasive pancreaticoduodenectomy in high volume centres, with the goal of reducing morbidity and improving patient outcomes. This study reports the successful implementation of a robotic pancreaticoduodenectomy (RPD) programme in the relatively low volume setting of Australia, measured against established, internationally accepted benchmarks for low-risk open pancreaticoduodenectomy (OPD).

Methods

Retrospective review of a prospectively maintained database for consecutive RPD at two Brisbane hospitals was performed, comparing data to internationally established benchmarks for low-risk OPD. A structured RPD programme was implemented by two surgeons across a study period spanning May 2017 to December 2023.

Results

Over the study period, seventy-two consecutive RPDs were performed, with 79 % for malignancy. Perioperative outcomes for transfusions, conversion rate, postoperative fistula rate, morbidity, mortality and oncological outcomes were all within established benchmark cutoffs for low-risk open pancreaticoduodenectomy (OPD), although operative time exceeded the benchmark value by 0.7hrs.

Conclusion

A carefully implemented RPD programme in the low volume Australian setting is feasible, with high quality outcomes achievable when compared to established benchmarks for low-risk OPD and to reported RPD series published by high volume pioneering centres.

背景：最近，越来越多的大手术量中心利用机器人平台进行微创胰十二指肠切除术，目的是降低发病率和改善患者预后。本研究报告了机器人胰十二指肠切除术（RPD）项目在澳大利亚相对较低的手术量环境中的成功实施情况，并与国际公认的低风险开放式胰十二指肠切除术（OPD）的既定基准进行了比较：方法：对布里斯班两家医院连续 RPD 的前瞻性数据库进行了回顾性审查，并将数据与国际公认的低风险 OPD 基准进行了比较。两名外科医生在2017年5月至2023年12月的研究期间实施了结构化RPD计划：在研究期间，共进行了72例连续RPD，其中79%为恶性肿瘤。围手术期的输血结果、转换率、术后瘘管率、发病率、死亡率和肿瘤结果均符合低风险开放式胰十二指肠切除术（OPD）的既定基准临界值，但手术时间超出基准值0.7小时：结论：在澳大利亚的低手术量环境中，精心实施的开放性胰十二指肠切除术是可行的，与低风险开放性胰十二指肠切除术的既定基准以及高手术量先驱中心发布的开放性胰十二指肠切除术系列报告相比，可获得高质量的结果。

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引用次数: 0

Protocol for a national, multicentre prospective study of acute pancreatitis management and outcomes: the PANORAMA study 全国性多中心急性胰腺炎管理和预后前瞻性研究：PANORAMA 研究协议。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.09.008

STRATA collaborative group

Aim

The primary aim of this study is to determine compliance with key quality performance indicators (QPIs) for the management of acute pancreatitis. The secondary aim is to examine the relationship between compliance to QPIs and clinical outcomes with factors that influence this.

Methods

This prospective cohort study will be conducted via the trainee-led STRATA collaborative network. All public hospitals in Aotearoa New Zealand will be eligible to participate. Data will be collected on all adult patients who are diagnosed with acute pancreatitis over a 3 month period. The primary outcome is compliance with the QPIs for the different domains of acute pancreatitis management. Secondary outcomes include early (30-days from index admission) clinical outcomes including incidence of locoregional complications, interventions, organ failure, and mortality.

Conclusion

This protocol describes the methodology for a nationwide prospective cohort study in Aotearoa New Zealand to evaluate compliance based on QPIs derived from the literature. These data will lay the foundation for future registry studies, clinical trials, and quality improvement initiatives.

目的：本研究的主要目的是确定急性胰腺炎治疗过程中关键质量绩效指标（QPI）的达标情况。次要目的是研究遵守 QPI 与临床结果之间的关系以及影响因素：这项前瞻性队列研究将通过受训人员领导的 STRATA 合作网络进行。新西兰奥特亚罗瓦的所有公立医院均有资格参与。将在 3 个月内收集所有被诊断为急性胰腺炎的成年患者的数据。主要结果是急性胰腺炎管理不同领域的 QPI 达标情况。次要结果包括早期（入院 30 天后）临床结果，包括局部并发症、干预、器官衰竭和死亡率的发生率：本方案介绍了在新西兰奥特亚罗瓦开展全国性前瞻性队列研究的方法，以评估基于文献中得出的 QPIs 的依从性。这些数据将为未来的登记研究、临床试验和质量改进计划奠定基础。

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引用次数: 0

Identifying an optimal cancer risk threshold for resection of pancreatic intraductal papillary mucinous neoplasms 确定切除胰腺导管内乳头状黏液瘤的最佳癌症风险阈值。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.10.006

Greg D. Sacks , Luke Wojtalik , Sarah R. Kaslow , Christina A. Penfield , Stella K. Kang , D.B. Hewitt , Ammar A. Javed , Christopher L. Wolfgang , R.S. Braithwaite

Background

IPMN consensus guidelines make implicit judgments on what cancer risk level should prompt surgery. We used decision modeling to estimate this cancer risk threshold (CRT) for BD-IPMN patients.

Methods

We created a decision model to compare quality-adjusted life years (QALYs) following surgery or surveillance for BD-IPMNs. We simulated treatment decisions for hypothetical patients, varying age, comorbidities and lesion location (pancreatic head/tail). The base case was a 60-year-old patient with mild comorbidities and pancreatic head IPMN. Probabilities, life expectancies, and utilities were incorporated from literature/public datasets. CRT was defined as the level of cancer risk at which the expected value of QALYs for surgery first exceeded that of surveillance.

Results

In the base case, surgery was preferred over surveillance, yielding 21.90 vs. 21.88 QALYs. The optimal CRT for a BD-IPMN patient depended on age, comorbidities, and location. CRT in the base case was 20 % and 3 % for an IPMN in the head and tail of the pancreas, respectively. Other drivers of preferred treatment were age and likelihood of postoperative mortality.

Conclusion

For BD-IPMNs, the optimal CRT varies depending on patient age and risk of surgical complications. Personalized risk threshold values could guide treatment decisions and inform future treatment consensus guidelines.

背景：IPMN共识指南对何种癌症风险水平应进行手术做出了隐性判断。我们使用决策模型来估算 BD-IPMN 患者的癌症风险阈值（CRT）：我们创建了一个决策模型来比较 BD-IPMN 手术或监测后的质量调整生命年 (QALY)。我们模拟了不同年龄、合并症和病变位置（胰头/胰尾）的假设患者的治疗决策。基础病例是一名 60 岁的患者，合并症较轻，患有胰头 IPMN。概率、预期寿命和效用均来自文献/公共数据集。CRT被定义为癌症风险水平，在这一水平上，手术的QALYs预期值首先超过监测的QALYs预期值：结果：在基础病例中，手术优于监测，其 QALYs 为 21.90：21.88。BD-IPMN患者的最佳CRT取决于年龄、合并症和发病部位。在基础病例中，胰头和胰尾 IPMN 的 CRT 分别为 20% 和 3%。其他影响首选治疗的因素包括年龄和术后死亡的可能性：结论：对于BD-IPMNs，最佳CRT因患者年龄和手术并发症风险而异。个性化的风险阈值可指导治疗决策，并为未来的治疗共识指南提供参考。

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引用次数: 0

Hospital charge and resource use analysis of extended-spectrum penicillin antibiotic therapy after pancreatoduodenectomy in intermediate- and high-risk patients 中高危患者胰十二指肠切除术后延长谱青霉素抗生素治疗的住院费用和资源使用分析。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb

Pub Date : 2025-01-01 DOI: 10.1016/j.hpb.2024.09.011

Alexander Loftus , Victoria S. Wu , Mohamedraed Elshami , Jonathan J. Hue , Lee M. Ocuin

Background

We previously reported that an extended antibiotic mitigation pathway following pancreatoduodenectomy in patients with intermediate-/high-risk glands is associated with 83 % lower odds of clinically relevant postoperative pancreatic fistula (CR-POPF). We now describe associations between the pathway, resource utilization, and hospital charges.

Methods

We performed a retrospective cohort study of patients who underwent elective pancreatoduodenectomy with soft gland texture and fistula risk score (FRS) ≥3 who received standard or extended antibiotics. Hospital charges and resource utilization within 90 days of surgery were compared by CR-POPF status and antibiotic pathway.

Results

A total of 34 patients received extended antibiotics and 53 received standard antibiotics. In patients with CR-POPF, patients who received extended antibiotics had lower likelihood of surgical or percutaneous reintervention (75.0 % vs. 100.0 %, p = 0.022). Ninety-day postoperative charges associated with CR-POPF were higher than no CR-POPF ($60,527 vs. $25,631, p = 0.028). Our risk-based model predicted a $15,825 decrease in hospital charges per patient receiving extended antibiotics.

Conclusions

CR-POPF is associated with higher 90-day hospital charges. Extended antibiotic therapy following pancreatoduodenectomy in patients with soft gland texture and FRS ≥3 is associated with fewer reinterventions in patients who develop CR-POPF. These outcomes will be formally tested in a randomized controlled trial (NCT05753735).

背景：我们以前曾报道过，对中/高危腺体患者进行胰十二指肠切除术后延长抗生素缓解路径可降低 83% 的临床相关术后胰瘘 (CR-POPF) 发生几率。现在，我们将介绍该路径、资源利用率和住院费用之间的关联：我们对接受择期胰十二指肠切除术、腺体质地较软、瘘管风险评分（FRS）≥3、接受标准或延长抗生素治疗的患者进行了回顾性队列研究。根据 CR-POPF 状态和抗生素使用途径比较了手术后 90 天内的住院费用和资源使用情况：结果：共有 34 名患者接受了扩展抗生素治疗，53 名患者接受了标准抗生素治疗。在 CR-POPF 患者中，接受延长抗生素治疗的患者接受手术或经皮再介入治疗的可能性较低（75.0% 对 100.0%，P = 0.022）。与 CR-POPF 相关的术后九十天费用高于未使用 CR-POPF 的费用（60,527 美元对 25,631 美元，p = 0.028）。我们基于风险的模型预测，每位接受延长抗生素治疗的患者住院费用将减少 15,825 美元：结论：CR-POPF 与较高的 90 天住院费用有关。对于腺体质地较软、FRS ≥3的患者，胰十二指肠切除术后延长抗生素疗程可减少发生CR-POPF患者的再次干预。这些结果将在随机对照试验（NCT05753735）中进行正式检验。

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