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Unplanned Hospital Encounters After Endoscopic Retrograde Cholangiopancreatography in 3 Large North American States.
北美 3 个大州内镜逆行胰胆管造影术后意外医院遭遇。
Bile Duct Disease Treatment Complications Quality Improvement
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摘要

BACKGROUND & AIMS:We have few population-level data on the performance of endoscopic retrograde cholangiopancreatography (ERCP) in the United States. We investigated the numbers of unplanned hospital encounters (UHEs), patient and facility factors associated with UHEs, and variation in quality and outcomes in the performance of ERCP in 3 large American states.
METHODS:We collected data on 68,642 ERCPs, performed at 635 facilities in California, Florida, and New York from 2009 through 2014. The primary endpoint was number of UHEs with an ERCP-related event within 7 days of ERCP; secondary endpoints included number of UHEs within 30 days and mortality within 30 days. Each facility was assigned a risk-standardized cohort, and variations in number of UHEs were analyzed with multivariable analysis.
RESULTS:Among all ERCPs, 5.8% resulted in a UHE within 7 days and 10.2% within 30 days. Performance of sphincterotomy was significantly associated with a higher risk of UHE at 7 and 30 days (P < .001). Younger age, female sex, and more advanced comorbidity were associated with UHE. There was substantial heterogeneity in rates of UHE among facilities: 4.2% at facilities in the 5th percentile and 25.2% at facilities in the 95th percentile. Increasing facility volume and ability to perform endoscopic ultrasonography were associated inversely with risk. The median number of ERCPs performed each year was 68.7, but 69% of facilities performed 100 or fewer ERCPs per year. Risk for UHE after sphincterotomy decreased with increasing facility volume until an inflection point of 157 ERCPs per year was reached.
CONCLUSIONS:In an analysis of outcomes of 68,642 ERCPs performed in 3 states, we found a higher-than-expected number of UHEs. There is substantial unexplained variation in risk for adverse events after ERCPs among facilities, and volume is the strongest predictor of risk. Annual facility volumes above approximately 150 ERCPs per year may protect against UHE.

译文

背景与目的: 在美国,我们几乎没有关于内窥镜逆行胰胆管造影术 (ERCP) 性能的人口水平数据。我们调查了美国 3 个大州的计划外医院遭遇 (UHEs) 的数量、与 UHEs 相关的患者和设施因素,以及 ERCP 绩效的质量和结果变化。
方法: 我们收集了 68,642 例 ERCPs 的数据,从 2009年到 2014年在加利福尼亚、佛罗里达和纽约的 635 家机构进行。主要终点是 ERCP 后 7 天内发生 ERCP 相关事件的 UHEs 数量; 次要终点包括 30 天内发生的 UHEs 数量和 30 天内的死亡率。每个机构都被分配了一个风险标准化队列,用多变量分析分析 UHEs 数量的变化。
结果: 在所有 ERCPs 中,5.8% 在 7 天内导致 UHE,10.2% 在 30 天内导致 UHE。括约肌切开术的表现与 7 天和 30 天的 UHE 风险较高显著相关 (P <.001)。更年轻的年龄、女性和更高级的共病与 UHE 相关。设施间的 UHE 比率存在巨大的异质性: 4.2% 百分位的设施为 25.2%,百分位的设施为。增加设备体积和进行超声内镜检查的能力与风险呈负相关。每年执行的 ERCPs 的中位数为 68.7,但 69% 的设施每年执行的 ERCPs 为 100 或更少。括约肌切开术后 UHE 的风险随着设施容量的增加而降低,直到达到每年 157 ERCPs 的拐点。
结论: 在对 3 个州 68,642 例 ERCPs 结果的分析中,我们发现 UHEs 的数量高于预期。ERCPs 后不良事件的风险在设施间存在大量无法解释的差异,并且容量是最强的风险预测因子。每年超过大约 150 ERCPs 的设施量可以防止 UHE。

Endoscopic Retrograde Cholangiopancreatography

消化 胆囊,胰腺疾病 临床研究术语
概述  :  

自从1968年内镜下逆行胆胰管造影术(Endoscopic Retrograde Cholangiopanc- reatography,ERCP)问世以来,尤其是1974年内镜下括约肌切开术(Endoscopi Sphincterotomy,EST)的临床应用,ERCP已成为临床诊断和治疗胆胰疾病的重要手段。 疗效与风险经过数十年的发展,ERCP已成为较为成熟的微创介入技术,是临床处理胆胰疾病的重要手段。对于有经验的操作者,经乳头胆管插管的成功率在95%以上,清除胆总管结石的成功率

endoscopic /,ɛndəs'kɑpɪk/

释义   adj. 内窥镜的;用内窥镜检查的

例句   Methods Endoscopic technique was used in pituitary adenoma resection for 32 patients.方法应用内窥镜切除垂体腺瘤32例。

 

retrograde 英 /ˈretrəɡreɪd/ 美 /ˈretrəɡreɪd/

释义   adj. 倒退的

例句   This is, as far as we're concerned, a real retrograde step for human rights.对我们而言,这是在人权问题上真正倒退的一步。

 

cholangiopancreatography 

释义   n. 胆管胰造影术

例句   The results showed that B type ultrasonography endoscopic retrograde cholangiopancreatography (ERCP) and abdominal plain X rays were the most useful diagnostic methods.结果表明:B超、腹部平片和内窥镜逆行胰胆管造影术(ERCP)是最有效的诊断手段。


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