国际胰腺外科研究小组 (ISGPS) 胰腺切除术后急性胰腺炎 (PPAP) 定义的临床和财务验证:国际多中心前瞻性研究。

IF 7.5 1区 医学 Q1 SURGERY Annals of surgery Pub Date : 2024-10-22 DOI:10.1097/SLA.0000000000006569
Elisa Bannone, Alice Cattelani, Gaetano Corvino, Alessio Marchetti, Valentina Andreasi, Francesca Fermi, Stefano Partelli, Nicolò Pecorelli, Domenico Tamburrino, Alessandro Esposito, Giuseppe Malleo, Manish Bhandare, Kaival Gundavda, Kuirong Jiang, Zipeng Lu, Jie Yin, Harish Lavu, Rosa Klotz, Daniela Merz, Christoph Michalski, Ulla Klaiber, Marco Montorsi, Gennaro Nappo, Naoki Ikenaga, Pasquale Scornamiglio, Bodil Andersson, Fraser Jeffery, Daniel Halloran, Robert Padbury, Ajith K Siriwardena, Savio George Barreto, Luca Gianotti, Attila Oláh, Christopher M Halloran, Saxon Connor, Roland Andersson, Jakob R Izbicki, Masafumi Nakamura, Alessandro Zerbi, Mohammad Abu Hilal, Martin Loos, Charles J Yeo, Yi Miao, Massimo Falconi, Christos Dervenis, John P Neoptolemos, Markus W Büchler, Marc G Besselink, Cristina Ferrone, Thilo Hackert, Roberto Salvia, Shailesh V Shrikhande, Oliver Strobel, Jens Werner, Christopher L Wolfgang, Giovanni Marchegiani
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引用次数: 0

摘要

目的验证胰十二指肠切除术(PD)后急性胰腺炎(PPAP)的ISGPS定义和分级系统:2022 年,国际胰腺外科研究小组(ISGPS)定义了胰腺切除术后急性胰腺炎(PPAP),并建议对其诊断标准和分级系统进行前瞻性验证:这是一项前瞻性国际多中心研究,包括欧洲、亚洲、大洋洲和美国 17 个胰腺转诊中心的急性胰腺炎患者。PPAP 诊断需要以下三个参数:(1)术后血清高淀粉酶血症/高脂血症(POH)在术后第 1 天和第 2 天持续存在;(2)符合 PPAP 的放射学改变;(3)与临床相关的患者病情恶化。为了验证分级系统,对所有级别的临床和经济参数进行了分析:在 2902 名接受腹腔镜手术的患者中,7.5%(n=218)的患者出现了 PPAP(6.3% 为 B 级,1.2% 为 C 级)。24.1%的患者出现 POH。住院时间与 PPAP 分级有关(无 POH/PPAP 10 天(IQR 7-17 天),B 级 22 天(IQR 15-34 天),C 级 43 天(IQR 27-54 天);PC 结论:这是首个针对 PPAP 的 ISGPS 定义和分级系统进行的前瞻性国际验证研究,强调了该病症的相关临床和财务影响。这些结果强调了对接受腹腔镜手术的患者进行 PPAP 常规筛查的重要性。
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Clinical and Financial Validation of the International Study Group for Pancreatic Surgery (ISGPS) Definition of Post-Pancreatectomy Acute Pancreatitis (PPAP): International Multicenter Prospective Study.

Objective: To validate the ISGPS definition and grading system of PPAP after pancreatoduodenectomy (PD).

Summary background data: In 2022, the International Study Group for Pancreatic Surgery (ISGPS) defined post-pancreatectomy acute pancreatitis (PPAP) and recommended a prospective validation of its diagnostic criteria and grading system.

Methods: This was a prospective, international, multicenter study including patients undergoing PD at 17 referral pancreatic centers across Europe, Asia, Oceania, and the United States. PPAP diagnosis required the following three parameters: (1) postoperative serum hyperamylasemia /hyperlipasemia (POH) persisting on postoperative days 1 and 2, (2) radiologic alterations consistent with PPAP, and (3) a clinically relevant deterioration in the patient's condition. To validate the grading system, clinical and economic parameters were analyzed across all grades.

Results: Among 2902 patients undergoing PD, 7.5% (n=218) developed PPAP (6.3% grade B and 1.2% grade C). POH occurred in 24.1% of patients. Hospital stay was associated with PPAP grades (No POH/PPAP 10 days (IQR 7-17) days, grade B 22 days (IQR 15-34) days, and grade C 43 days (IQR 27-54) days; P<0.001), as well as intensive care unit admission (No POH/PPAP 5.4%, grade B 12.6%, grade C 82.9%; P<0.010), and hospital readmission rates (No POH/PPAP 7.3%, grade B 16.1%, grade C 18.5%; P<0.05). Costs of grade B and C PPAP were 2 and 11 times greater than uncomplicated clinical course, resp. (P<0.001).

Conclusions: This first prospective, international validation study of the ISGPS definition and grading system for PPAP highlighted the relevant clinical and financial implications of this condition. These results stress the importance of routine screening for PPAP in patients undergoing PD.

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来源期刊
Annals of surgery
Annals of surgery 医学-外科
CiteScore
14.40
自引率
4.40%
发文量
687
审稿时长
4 months
期刊介绍: The Annals of Surgery is a renowned surgery journal, recognized globally for its extensive scholarly references. It serves as a valuable resource for the international medical community by disseminating knowledge regarding important developments in surgical science and practice. Surgeons regularly turn to the Annals of Surgery to stay updated on innovative practices and techniques. The journal also offers special editorial features such as "Advances in Surgical Technique," offering timely coverage of ongoing clinical issues. Additionally, the journal publishes monthly review articles that address the latest concerns in surgical practice.
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