Thibaut Bitterlin, Caroline Valibouze, Xavier Lenne, Amélie Bruandet, Pierre Desreumaux, Philippe Zerbib
{"title":"克罗恩病回肠结肠切除术的术后发病率与医院手术量和手术结果的关系:一项针对 4205 名患者的法国全国性研究。","authors":"Thibaut Bitterlin, Caroline Valibouze, Xavier Lenne, Amélie Bruandet, Pierre Desreumaux, Philippe Zerbib","doi":"10.1093/ecco-jcc/jjae010","DOIUrl":null,"url":null,"abstract":"<p><strong>Background and aims: </strong>Despite the development of medical therapy, nearly 50% of patients with Crohn's disease [CD] undergo surgery during their lifetime. Several studies have suggested some risk factors for postoperative morbidity [POM] after ileocolic resection [ICR]. However, the impact of surgical hospital volume on POM in CD has not been extensively studied. This study aimed to assess the impact of surgical hospital volume on POM after ICR for CD.</p><p><strong>Methods: </strong>All patients with CD who underwent ICR in France between 2013 and 2022 were identified in the French Database, Programme de Médicalisation des Systèmes d'Information. Using the Chi-square automatic interaction detector, we determined the cut-off value to split high-surgical-volume [≥6 ICRs/year] and low-surgical-volume centres [<6 ICRs/year]. The primary outcome was the evaluation of major POM during hospitalization. POM was evaluated according to the surgical volume centre. The Elixhauser comorbidity index [ECI] was used to categorize the comorbidities of patients.</p><p><strong>Results: </strong>A total of 4205 patients were identified, and the major POM during hospitalization was significantly [p = 0.0004] lower in the high-surgical-volume [6.2%] compared to low-surgical-volume centres [9.1%]. After multivariate analysis, independent factors associated with major POM were surgical hospital volume [p = 0.024], male sex [p = 0.029], ECI ≥ 1 [p < 0.001], and minor POM [p < 0.001].</p><p><strong>Conclusion: </strong>Major POM after ICR for CD is closely associated with surgical hospital volume. Centralization of surgery for CD is desirable, especially in patients with major comorbidities.</p>","PeriodicalId":94074,"journal":{"name":"Journal of Crohn's & colitis","volume":null,"pages":null},"PeriodicalIF":0.0000,"publicationDate":"2024-08-06","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Hospital Surgical Volume-Outcome Relationship of Postoperative Morbidity for Ileocolic Resection in Crohn's Disease: A French Nationwide Study of 4205 Patients.\",\"authors\":\"Thibaut Bitterlin, Caroline Valibouze, Xavier Lenne, Amélie Bruandet, Pierre Desreumaux, Philippe Zerbib\",\"doi\":\"10.1093/ecco-jcc/jjae010\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background and aims: </strong>Despite the development of medical therapy, nearly 50% of patients with Crohn's disease [CD] undergo surgery during their lifetime. Several studies have suggested some risk factors for postoperative morbidity [POM] after ileocolic resection [ICR]. However, the impact of surgical hospital volume on POM in CD has not been extensively studied. This study aimed to assess the impact of surgical hospital volume on POM after ICR for CD.</p><p><strong>Methods: </strong>All patients with CD who underwent ICR in France between 2013 and 2022 were identified in the French Database, Programme de Médicalisation des Systèmes d'Information. Using the Chi-square automatic interaction detector, we determined the cut-off value to split high-surgical-volume [≥6 ICRs/year] and low-surgical-volume centres [<6 ICRs/year]. The primary outcome was the evaluation of major POM during hospitalization. POM was evaluated according to the surgical volume centre. The Elixhauser comorbidity index [ECI] was used to categorize the comorbidities of patients.</p><p><strong>Results: </strong>A total of 4205 patients were identified, and the major POM during hospitalization was significantly [p = 0.0004] lower in the high-surgical-volume [6.2%] compared to low-surgical-volume centres [9.1%]. After multivariate analysis, independent factors associated with major POM were surgical hospital volume [p = 0.024], male sex [p = 0.029], ECI ≥ 1 [p < 0.001], and minor POM [p < 0.001].</p><p><strong>Conclusion: </strong>Major POM after ICR for CD is closely associated with surgical hospital volume. Centralization of surgery for CD is desirable, especially in patients with major comorbidities.</p>\",\"PeriodicalId\":94074,\"journal\":{\"name\":\"Journal of Crohn's & colitis\",\"volume\":null,\"pages\":null},\"PeriodicalIF\":0.0000,\"publicationDate\":\"2024-08-06\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Journal of Crohn's & colitis\",\"FirstCategoryId\":\"1085\",\"ListUrlMain\":\"https://doi.org/10.1093/ecco-jcc/jjae010\",\"RegionNum\":0,\"RegionCategory\":null,\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"\",\"PubModel\":\"\",\"JCR\":\"\",\"JCRName\":\"\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of Crohn's & colitis","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1093/ecco-jcc/jjae010","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"","JCRName":"","Score":null,"Total":0}
引用次数: 0
摘要
背景和目的:尽管药物治疗得到了发展,但近50%的克罗恩病(CD)患者终生都要接受手术治疗。有几项研究提出了回结肠切除术(ICR)术后发病率(POM)的一些风险因素。然而,手术住院量对 CD 术后发病率的影响尚未得到广泛研究。本研究旨在评估手术医院容积对 CD ICR 术后 POM 的影响:在法国数据库 "Programme de Médicalisation des Systèmes d'Information "中识别了2013年至2022年期间在法国接受ICR治疗的所有CD患者。通过Chi-square自动交互检测器,我们确定了划分高手术量(≥6例ICR/年)和低手术量中心的临界值(结果:高手术量中心(6.2%)与低手术量中心(9.1%)相比,住院期间的主要 POM 显著降低(p = 0.0004)。经过多变量分析,与主要POM相关的独立因素是手术医院数量(P = 0.024)、男性性别(P = 0.029)、ECI ≥1(P < 0.001)和轻微POM(P < 0.001):结论:ICR治疗CD后的主要POM与手术住院量密切相关。CD手术最好集中进行,尤其是对有重大并发症的患者。
Hospital Surgical Volume-Outcome Relationship of Postoperative Morbidity for Ileocolic Resection in Crohn's Disease: A French Nationwide Study of 4205 Patients.
Background and aims: Despite the development of medical therapy, nearly 50% of patients with Crohn's disease [CD] undergo surgery during their lifetime. Several studies have suggested some risk factors for postoperative morbidity [POM] after ileocolic resection [ICR]. However, the impact of surgical hospital volume on POM in CD has not been extensively studied. This study aimed to assess the impact of surgical hospital volume on POM after ICR for CD.
Methods: All patients with CD who underwent ICR in France between 2013 and 2022 were identified in the French Database, Programme de Médicalisation des Systèmes d'Information. Using the Chi-square automatic interaction detector, we determined the cut-off value to split high-surgical-volume [≥6 ICRs/year] and low-surgical-volume centres [<6 ICRs/year]. The primary outcome was the evaluation of major POM during hospitalization. POM was evaluated according to the surgical volume centre. The Elixhauser comorbidity index [ECI] was used to categorize the comorbidities of patients.
Results: A total of 4205 patients were identified, and the major POM during hospitalization was significantly [p = 0.0004] lower in the high-surgical-volume [6.2%] compared to low-surgical-volume centres [9.1%]. After multivariate analysis, independent factors associated with major POM were surgical hospital volume [p = 0.024], male sex [p = 0.029], ECI ≥ 1 [p < 0.001], and minor POM [p < 0.001].
Conclusion: Major POM after ICR for CD is closely associated with surgical hospital volume. Centralization of surgery for CD is desirable, especially in patients with major comorbidities.