使用自我评估的荷兰国家ERCP质量注册与临床ERCP结果不相关

L. Gilissen, S. Meijer, H. Flink, P. Friederich, Jos Ramaker, E. Schoon, A. Stronkhorst
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摘要

背景:内镜手术质量测量是一个现实而重要的课题。在荷兰,内窥镜医生有义务在国家内窥镜逆行胆管造影(ERCP)质量注册(NEQR)中注册他们的内窥镜逆行胆管造影(ERCP)表现。NEQR是一种自我评估,评估ERCP质量和每个中心和内窥镜医师的体积,但并发症和手术结果都没有在NEQR中登记。本研究的目的是检查NEQR是否与三级转诊中心ercp后的客观临床结果相关。材料和方法:2016年在三级转诊中心进行的所有ercp回顾性队列研究。测量NEQR自我评估与ercp术后并发症和死亡率的相关性。结果:共完成333例手术,其中254例在NEQR中登记,占76.3%。主观自我评价与ercp后客观结果之间无显著相关性。在所有333例手术中,ercp术后并发症发生率为13.5%,ercp相关30天死亡率为0.6%。结论:目前使用的NEQR与术后临床结果无关。应实施ercp后30天的临床结果测量,包括并发症,以提高该特定质量注册的有效性。
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The Dutch national ERCP quality registration using self-assessment does not correlate with clinical ERCP outcome
Background: Quality measurement of endoscopic procedures is an actual and important subject. In the Netherlands endoscopists are obligated to register their Endoscopic Retrograde Cholangiopancreatography (ERCP) performances in a National ERCP quality registration (NEQR). NEQR is a self-assessment that evaluates ERCP quality and volume per centre and endoscopist, but complications and outcome of the procedure are both not registered in NEQR. The aim of this study is to examine whether NEQR correlates with objective post-ERCP clinical outcome in a tertiary referral centre. Material and methods: A retrospective cohort study of all ERCPs performed at a tertiary referral centre in 2016. Correlations between NEQR self-assessments and post-ERCP complications and mortality were measured. Results: 333 procedures were performed, of which 254 were registered in the NEQR (76.3%). No significant correlations were found between the subjective self- assessment and objective post-ERCP outcomes. Of all 333 procedures the total post-ERCP complication rate was 13.5% and the ERCP-related 30-day mortality rate was 0.6%. Conclusions: The currently used NEQR does not correlate with post-procedural clinical outcomes. Clinical outcome measures in a 30-day post-ERCP period, including complications, should be implemented to improve the usefulness of this specific quality registration.
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