Beeinflussen Mindestmengen die Ergebnisse der Pankreaschirurgie?

Zusammenfassung

Mindestmengen sind eines der meist diskutierten, aber auch umstrittensten Themen der aktuellen Chirurgie. Solche Mindestmengen scheinen bei keiner anderen Entität soviel Einfluss auf die Morbidität und vor allem Mortalität zu haben, wie bei der Pankreaschirurgie. Trotz stetig sinkender Mortalität bleibt die Morbidität der Pankreaschirurgie auch in Zentren relativ hoch. Zahlreiche Studien konnten eine Senkung der kurzfristigen Mortalität durch Fallzahlengenerierung von über 10 Patienten pro Jahr um über 50% demonstrieren. In unserem eigenen Patientengut konnten wir in zwei sukzessiven Zeiträumen eine signifikante Senkung der Mortalität um 4% auf 1% und eine signifikante Reduktion der Morbidität von 47% auf 35% demonstrieren. Wir geben einen Überblick über die Faktoren, die die Mortalität und Komplikationsrate der Pankreaschirurgie am Zentrum senken und fassen bisher zu diesem Thema publizierte Studien zusammen. Unsere Ergebnisse wie auch weitere Studien aus Deutschland und anderen Ländern zeigen, dass eine zunehmende Zentrumserfahrung als auch die Operation in einem „high volume hospital” die Komplikationsrate und vor allem die Mortalität nach Pankreaskopfresektion senken.

Abstract

Hospital volume is one of the most discussed but also disputed subjects of surgery during the recent years. In no other surgical entity as in pancreatic surgery the number of performed operations has as much influence on morbidity and mortality. Despite of decreasing mortality, morbidity in pancreatic surgery remains relatively high even in specialized centres. Numerous studies demonstrated a reduction of perioperative mortality in centres with more than 10 patients per year by over 50%. In our own collective we demonstrated a significant reduction of mortality by 4% to 1% in two successive periods and a significant reduction of morbidity from 47% to 35%. We review the factors that are held responsible for decreasing mortality and complication rate in specialized centres and review published studies on this subject up to date. Our results confirm studies form other countries that increasing centre experience as well as operations performed in high volume hospitals decrease the complication rate and mortality after pancreatic head resection.

Pankreaschirurgie - Pankreaskopfresektion - Mindestmengen - Komplikationen - Übersichtsarbeit

Pancreatic surgery - pancreatic head resection - hospital volume - complications - review

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