糖尿病对胰腺手术患者术后并发症的影响。

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY Hpb Pub Date : 2024-12-30 DOI:10.1016/j.hpb.2024.12.020

Sandra de Kalbermatten, David Martin, Emilie Uldry, Emmanuel Melloul, Nicolas Demartines, David Fuks, Gaëtan-Romain Joliat

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引用次数: 0

摘要

背景：ERAS方案减少了术后并发症，但其对行胰腺切除术的糖尿病患者的影响的数据很少。本研究评估糖尿病（DM）是否是ERAS项目中胰腺切除术后发病的预测因子。方法：横断面研究包括所有接受胰腺切除术（2012-2022）并遵循ERAS途径的患者。采用多变量分析确定糖尿病是否是发病率预测因子。评估ERAS依从性与发病率之间的关系。结果：共纳入558例患者（女性266例，中位年龄66岁，中位体重指数25）。大多数患者行开腹胰十二指肠切除术（n=369, 66%）。ERAS总体依从性≤60%的糖尿病患者发病率为38/40(95%)，而ERAS总体依从性≤60%的糖尿病患者发病率降至37/50 （74%,p=0.008）。糖尿病不是并发症的独立预测因素（OR 0.7, 95%CI 0.4-1.2, p=0.186），而体重指数>25 kg/m2和术前胆道支架置入术是术前发病率的预测因素(OR 1.1, 95%CI 1.0-1.1, p=0.049；OR 1.7, 95%CI 1.0-2.5, p=0.044)。结论：本研究显示糖尿病与ERAS项目中胰腺切除术后并发症无关。它强调了良好的ERAS依从性对于降低糖尿病患者术后并发症的风险的重要性。

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Impact of diabetes mellitus on postoperative complications in patients undergoing pancreatic surgery.

Background: Enhanced Recovery After Surgery (ERAS) protocols decrease postoperative complications, but data on their effect on diabetic patients undergoing pancreatectomy are scarce. This study assessed whether diabetes mellitus (DM) was a morbidity predictor after pancreatectomy within an ERAS program.

Methods: A cross-sectional study including all patients who underwent pancreatectomy (2012-2022) and followed an ERAS pathway was performed. Multivariable analysis was used to determine whether DM was a morbidity predictor. Association between ERAS compliance and morbidity rate was assessed.

Results: A total of 558 patients were included (266 women, median age 66, median body-mass index 25). Most patients underwent open pancreatoduodenectomy (n=369, 66%). In diabetic patients with overall ERAS compliance≤60 %, morbidity was 38/40 (95%), whereas in diabetic patients with overall ERAS compliance>60 %, it decreased to 37/50 (74%, p=0.008). DM was not found as an independent complication predictor (OR 0.7, 95%CI 0.4-1.2, p=0.186), while body-mass index>25 kg/m² and preoperative biliary stenting were preoperative morbidity predictors (OR 1.1, 95%CI 1.0-1.1, p=0.049; OR 1.7, 95%CI 1.0-2.5, p=0.044).

Conclusion: This study showed that DM was not associated with postoperative complications after pancreatectomy within an ERAS program. It highlighted the importance of a good ERAS compliance to decrease the risk of postoperative complications in DM patients.

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).