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首页> 外文期刊>Surgical Endoscopy >Stenting versus gastrojejunostomy for management of malignant gastric outlet obstruction: Comparison of clinical outcomes and costs
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Stenting versus gastrojejunostomy for management of malignant gastric outlet obstruction: Comparison of clinical outcomes and costs

机译：支架置入与胃空肠吻合术治疗恶性胃出口梗阻：临床结果和费用的比较

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Background: Although endoscopic stenting is increasingly performed, surgical gastrojejunostomy (GJ) is still considered the gold standard for relief of malignant gastric outlet obstruction (GOO). The aim of this study is to compare clinical outcomes and hospital costs between patients undergoing GJ or stenting for management of malignant GOO. Methods: A retrospective claims analysis of the Medicare (MedPAR) database was conducted to identify all inpatient hospitalizations for GJ or endoscopic stenting for malignant GOO during 2007-2008. The main outcome measure evaluated using the MedPAR database was a comparison of the total length of hospital stay (LOS) and costs associated with both techniques. As MedPAR is a claims database that does not provide outcomes at patient level, a single-institution retrospective study was conducted to compare the rates of technical and treatment success, post-procedure LOS, and delayed complications per patient between the two techniques. Results: The MedPAR claims data evaluated 425 stenting and 339 GJ hospitalizations. Compared with GJ, median LOS (8 vs. 16 days; p < 0.0001) and median cost (US $15,366 vs. US $27,391; p < 0.0001) per claim were both significantly lower for stenting. Stenting was more commonly performed at urban versus rural hospitals (89 % vs. 11 %; p < 0.0001), teaching versus non-teaching hospitals (59 % vs. 41 %, p = 0.0005), and academic institutions (56 % vs. 44 %; p = 0.0157). The institutional patient data analysis included 29 patients who underwent stenting and 75 who underwent surgical GJ. While both modalities were technically successful and relieved gastric outlet obstruction in all cases, compared with surgical GJ, the median post-procedure LOS was significantly lower for enteral stenting (1.5 vs. 10.7 days, p < 0.0001). There was no difference in rates of delayed complications between stenting and surgical GJ (13.8 % vs. 6.7 %; p = 0.26). Conclusions: While the technical and clinical outcomes of surgical GJ and endoscopic stenting appear comparable, stent placement is less costly and is associated with shorter length of hospital stay. Dissemination of endoscopic stenting beyond teaching, academic hospitals located in urban areas as a treatment for malignant GOO is important given its implications for patient care and resource utilization.
机译：背景：尽管越来越多地采用内窥镜支架置入术，但手术胃空肠吻合术（GJ）仍被认为是缓解恶性胃出口梗阻（GOO）的金标准。本研究的目的是比较接受GJ或支架置入治疗恶性GOO的患者的临床结局和住院费用。方法：对Medicare（MedPAR）数据库进行回顾性索赔分析，以确定2007-2008年期间所有住院的GJ住院或恶性GOO的内镜支架置入术。使用MedPAR数据库评估的主要结局指标是比较住院总时间（LOS）和与这两种技术相关的费用。由于MedPAR是一个无法在患者水平提供结果的索赔数据库，因此进行了单机构回顾性研究，以比较两种技术之间技术和治疗成功率，术后LOS以及每位患者延迟并发症的发生率。结果：MedPAR声称的数据评估了425例支架置入和339例GJ住院治疗。与GJ相比，支架植入术的每项索赔中位数LOS（8天对比16天; p <0.0001）和中位数成本（15,366美元对比27,391美元; p <0.0001）均显着降低。在城市医院和农村医院（89％对11％; p <0.0001），教学医院对非教学医院（59％对41％，p = 0.0005）和学术机构（56％vs. 0005）更普遍进行支架手术。 44％; p ＝ 0.0157）。机构患者数据分析包括29例接受了支架置入术的患者和75例接受了手术GJ的患者。尽管两种方法在技术上都成功并且在所有情况下均缓解了胃出口梗阻，但与外科手术GJ相比，肠支架置入术的中位术后LOS明显降低（1.5天比10.7天，p <0.0001）。支架置入术和手术GJ之间延迟并发症的发生率无差异（13.8％比6.7％; p = 0.26）。结论：尽管外科手术GJ和内窥镜支架置入术的技术和临床效果似乎相当，但支架置入术的成本较低，并且住院时间较短。考虑到其对患者护理和资源利用的影响，传播内窥镜支架超出教学范围，位于市区的学术医院作为治疗恶性GOO的重要手段。

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