Feasibility and Safety of a “Shared Care” Model in Complex Hepatopancreatobiliary Surgery

Abstract

Objective: To determine the safety of a fully functioning shared care model (SCM) in hepatopancreatobiliary surgery through evaluating outcomes in pancreaticoduodenectomy. Background: SCMs, where a team of surgeons share in care delivery and resource utilization, represent a surgeon-level opportunity to improve system efficiency and peer support, but concerns around clinical safety remain, especially in complex elective surgery. Methods: Patients who underwent pancreaticoduodenectomy between 2016 and 2020 were included. Adoption of shared care was demonstrated by analyzing shared care measures, including the number of surgeons encountered by patients during their care cycle, the proportion of patients with different consenting versus primary operating surgeon (POS), and the proportion of patients who met their POS on the day of surgery. Outcomes, including 30-day mortality, readmission, unplanned reoperation, sepsis, and length of stay, were collected from the institution's National Surgical Quality Improvement Program (NSQIP) database and compared with peer hospitals contributing to the pancreatectomy-specific NSQIP collaborative. Results: Of the 174 patients included, a median of 3 surgeons was involved throughout the patients' care cycle, 69.0% of patients had different consenting versus POS and 57.5% met their POS on the day of surgery. Major outcomes, including mortality (1.1%), sepsis (5.2%), and reoperation (7.5%), were comparable between the study group and NSQIP peer hospitals. Length of stay (10 day) was higher in place of lower readmission (13.2%) in the study group compared with peer hospitals. Conclusions: SCMs are feasible in complex elective surgery without compromising patient outcomes, and wider adoption may be encouraged.

Mapping a shared care model in complex gastrointestinal surgery: A qualitative study of queues and stakeholders within a Canadian general surgery practice

“…32,33 Other traditional concerns around SCMs revolve around loss of continuity of care and erosion of patient trust, yet there is evidence that patients accept shared care in the context of improved access while having confidence in any of the surgeons within a group. 8,13,18…”

“…Previous studies have described one specific general surgery SCM at an academic tertiary centre that has not been formally mapped from the perspective of a CAS. 7,18 Through evaluating this model, this study aimed to identify the queues and stakeholders within a complex Gastrointestinal (GI) surgical care pathway to demonstrate the potential implications of a functional SCM on system access and efficiency.…”