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Qruxx, juni 2018Bekijk artikel
Publicatie met data uit de Dutch Pancreatic Cancer Audit (DPCA) verschenen in het HPB:
Variation in hospital mortality after pancreatoduodenectomy is related to failure to rescue rather than major complications: a nationwide audit.
Auteurs: van Rijssen, L. B., Zwart, M. J., van Dieren, S., de Rooij, T., Bonsing, B. A., Bosscha, K., van Dam, R. M., van Eijck, C. H., Gerhards, M. F.,
Gerritsen, J. J., van der Harst, E., de Hingh, I. H., de Jong, K. P., Kazemier, G., Klaase, J., van der Kolk, B. M., van Laarhoven, C. J., Luyer, M. D., Molenaar, I. Q., Patijn, G. A., Rupert, C. G., Scheepers, J. J., van der Schelling, G. P., Vahrmeijer, A. L., Busch, O. R. C., van Santvoort, H. C., Groot Koerkamp, B., Besselink, M. G., van Gulik, T. M., Festen, S., Karsten, T. M. & Coene, P. P.
Klik hier voor het volledige artikel of lees de samenvatting hieronder:
In the mandatory nationwide Dutch Pancreatic Cancer Audit, rates of major complica- tions and Failure to Rescue (FTR) after pancreatoduodenectomy between low- and high-mortality hos- pitals are compared, and independent predictors for FTR investigated.
Patients undergoing pancreatoduodenectomy in 2014 and 2015 in The Netherlands were included. Hospitals were divided into quartiles based on mortality rates. The rate of major complications (Clavien-Dindo !3) and death after a major complication (FTR) were compared between these quartiles. Independent predictors for FTR were identified by multivariable logistic regression analysis.
Out of 1.342 patients, 391 (29%) developed a major complication and in-hospital mortality was 4.2%. FTR occurred in 56 (14.3%) patients. Mortality was 0.9% in the first hospital quartile (4 hospitals, 327 patients) and 8.1% in the fourth quartile (5 hospitals, 310 patients). The rate of major complications increased by 40% (25.7% vs 35.2%) between the first and fourth hospital quartile, whereas the FTR rate increased by 560% (3.6% vs 22.9%). Independent predictors of FTR were male sex (OR = 2.1, 95%CI 1.2–3.9), age >75 years (OR = 4.3, 1.8–10.2), BMI !30 (OR = 2.9, 1.3–6.6), histopathological diagnosis of periampullary cancer (OR = 2.0, 1.1–3.7), and hospital volume <30 (OR = 3.9, 1.6–9.6).
Variations in mortality between hospitals after pancreatoduodenectomy were explained mainly by differences in FTR, rather than the incidence of major complications.