Failure to rescue in patients with distal pancreatectomy: a nationwide analysis of 10,632 patients

Lequeu, Jean-Baptiste; Cottenet, Jonathan; Facy, Olivier; Perrin, Thomas; Bernard, Alain; Quantin, Catherine

doi:10.1016/j.hpb.2021.02.002

Cited by 8 publications

(4 citation statements)

References 36 publications

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“…Furthermore, FTR rates found in the current study were also better when compared with the GAPASURG study: 13.3% (the Netherlands), 10.9% (Sweden), and 10.2% (Germany), but still worse as compared with the 5.4% reported for the United States/Canada 5 . After distal pancreatectomy, FTR (8.8%–7.1% and 5.9%) and mortality rates (1.6%–1.5% and 1.3%) in the current study were lower in all time periods compared with a recent nationwide French administrative database that reported FTR (11.2%) and mortality (3.9%) rates of 10,632 patients 30 . However, the French analysis reported 90-day mortality, rather than in-hospital mortality in the present study.…”

Section: Discussioncontrasting

confidence: 71%

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Outcome of Pancreatic Surgery During the First 6 Years of a Mandatory Audit Within the Dutch Pancreatic Cancer Group

Suurmeijer¹,

Henry²,

Bonsing³

et al. 2022

Annals of Surgery

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Objective: To describe outcome after pancreatic surgery in the first 6 years of a mandatory nationwide audit. Background: Within the Dutch Pancreatic Cancer Group, efforts have been made to improve outcome after pancreatic surgery. These include collaborative projects, clinical auditing, and implementation of an algorithm for early recognition and management of postoperative complications. However, nationwide changes in outcome over time have not yet been described. Methods: This nationwide cohort study included consecutive patients after pancreatoduodenectomy (PD) and distal pancreatectomy from the mandatory Dutch Pancreatic Cancer Audit (January 2014–December 2019). Patient, tumor, and treatment characteristics were compared between 3 time periods (2014–2015, 2016–2017, and 2018–2019). Short-term surgical outcome was investigated using multilevel multivariable logistic regression analyses. Primary endpoints were failure to rescue (FTR) and in-hospital mortality. Results: Overall, 5345 patients were included, of whom 4227 after PD and 1118 after distal pancreatectomy. After PD, FTR improved from 13% to 7.4% [odds ratio (OR) 0.64, 95% confidence interval (CI) 0.50–0.80, P<0.001] and in-hospital mortality decreased from 4.1% to 2.4% (OR 0.68, 95% CI 0.54–0.86, P=0.001), despite operating on more patients with age >75 years (18%–22%, P=0.006), American Society of Anesthesiologists score ≥3 (19%–31%, P<0.001) and Charlson comorbidity score ≥2 (24%–34%, P<0.001). The rates of textbook outcome (57%–55%, P=0.283) and major complications remained stable (31%–33%, P=0.207), whereas complication-related intensive care admission decreased (13%–9%, P=0.002). After distal pancreatectomy, improvements in FTR from 8.8% to 5.9% (OR 0.65, 95% CI 0.30–1.37, P=0.253) and in-hospital mortality from 1.6% to 1.3% (OR 0.88, 95% CI 0.45–1.72, P=0.711) were not statistically significant. Conclusions: During the first 6 years of a nationwide audit, in-hospital mortality and FTR after PD improved despite operating on more high-risk patients. Several collaborative efforts may have contributed to these improvements.

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Section: Discussioncontrasting

confidence: 71%

“…(11.2%) and mortality (3.9%) rates of 10,632 patients. 30 However, the French analysis reported 90-day mortality, rather than in-hospital mortality in the present study. A recent study presented the first results from the Swedish National Pancreatic and Periampullary Cancer Registry.…”

Section: Discussioncontrasting

confidence: 55%

Outcome of Pancreatic Surgery During the First 6 Years of a Mandatory Audit Within the Dutch Pancreatic Cancer Group

Suurmeijer¹,

Henry²,

Bonsing³

et al. 2022

Annals of Surgery

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“…More importantly, we were able to rescue 89% of patients from major complications. The failure rate (12.1%) was at the upper limit of that reported from high-volume centers, ranging from 5.4%[ 8 ] to 12.5%[ 19 ]. This means there may still be room for improvement in complication management at our center.…”

Section: Discussionmentioning

confidence: 97%

Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center: Value of tailored peri-pancreatectomy protocols

Cawich,

Dixon,

Shukla

et al. 2024

World J Gastrointest Surg

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BACKGROUND Pancreaticoduodenectomy (PD) is a technically complex operation, with a relatively high risk for complications. The ability to rescue patients from post-PD complications is as a recognized quality measure. Tailored protocols were instituted at our low volume facility in the year 2013. AIM To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of quality. METHODS A retrospective audit was performed to collect data from patients who experienced major post-PD complications at a low volume pancreatic surgery unit in Trinidad and Tobago between January 1, 2013 and June 30, 2023. Standardized definitions from the International Study Group of Pancreatic Surgery were used to define post-PD complications, and the modified Clavien-Dindo classification was used to classify post-PD complications. RESULTS Over the study period, 113 patients at a mean age of 57.5 years (standard deviation [SD] ± 9.23; range: 30-90; median: 56) underwent PDs at this facility. Major complications were recorded in 33 (29.2%) patients at a mean age of 53.8 years (SD: ± 7.9). Twenty-nine (87.9%) patients who experienced major morbidity were salvaged after aggressive treatment of their complication. Four (3.5%) died from bleeding pseudoaneurysm (1), septic shock secondary to a bile leak (1), anastomotic leak (1), and myocardial infarction (1). There was a significantly greater salvage rate in patients with American Society of Anesthesiologists scores ≤ 2 (93.3% vs 25%; P = 0.0024). CONCLUSION This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring PD. Despite low volumes at our facility, we demonstrated that 87.9% of patients were rescued from major complications. We attributed this to several factors including development of rescue protocols, the competence of the pancreatic surgery teams and continuous, and adaptive learning by the entire institution, culminating in the development of tailored peri-pancreatectomy protocols.

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“…We read with great interest the article recently published by Lequeu et al (1) based on the French national administrative prospective database for hospital care (PMSI: Programme de Médicalisation des Systèmes d'Information) containing all discharge reports from both private and public hospitals in France. This series aimed at evaluating the influence of hospital volume on failure to rescue after distal pancreatectomy (DP) with or without splenectomy by open and minimally invasive surgery.…”

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confidence: 99%

Comment on: Failure to rescue in patients with distal pancreatectomy: a nationwide analysis of 10,632 patients

Marchese¹,

Fuks²,

Truant³

et al. 2021

Hepatobiliary Surg Nutr

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Failure to rescue in patients with distal pancreatectomy: a nationwide analysis of 10,632 patients

Cited by 8 publications

References 36 publications

Outcome of Pancreatic Surgery During the First 6 Years of a Mandatory Audit Within the Dutch Pancreatic Cancer Group

Outcome of Pancreatic Surgery During the First 6 Years of a Mandatory Audit Within the Dutch Pancreatic Cancer Group

Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center: Value of tailored peri-pancreatectomy protocols

Comment on: Failure to rescue in patients with distal pancreatectomy: a nationwide analysis of 10,632 patients

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