High Performing Whipple Patients: Factors Associated with Short Length of Stay after Open Pancreaticoduodenectomy

Lee, Grace C.; Fong, Zhi Ven; Ferrone, Cristina R.; Thayer, Sarah P.; Warshaw, Andrew L.; Lillemoe, Keith D.; Castillo, Carlos Fernández‐del

doi:10.1007/s11605-014-2604-3

Cited by 44 publications

(34 citation statements)

References 46 publications

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“…20 As a result, there is much focus on reducing hospital costs by decreasing duration of stay and hospital readmissions, especially for complex surgical procedures. 21,22 Our results demonstrating an association between preoperative anemia and increased use of hospital resources are supported by several other studies. 1,[23][24][25][26] In patients undergoing colorectal surgery, patients with preoperative anemia were hospitalized for 2.2 days greater than patients with normal preoperative hematocrit.…”

Section: Discussionsupporting

confidence: 86%

Preoperative anemia is associated with increased use of hospital resources in patients undergoing elective hepatectomy

Tee

Shubert

Ubl

et al. 2015

Surgery

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Section: Discussionsupporting

confidence: 86%

Preoperative anemia is associated with increased use of hospital resources in patients undergoing elective hepatectomy

Tee

Shubert

Ubl

et al. 2015

Surgery

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“…Overall clinically relevant morbidity (Clavien III-V) was also low, noted in 14.5% of the entire cohort. This compares favorably to other reported large series of surgical outcomes of PD (8,(20)(21)(22)(23)(24)(25). The low morbidity seen in this series resulted in low intensive care use, short hospital stay, and low readmission rate.…”

Section: Discussionsupporting

confidence: 78%

“…In this cohort of patients undergoing PD by a single surgeon at the beginning of their career, the overall outcomes are similar and well within the acceptable range for other centers of excellence (8,(20)(21)(22)(23)(24)(25). There was an increase in the use of neoadjuvant chemotherapy, vein resection, and additional procedures seen in the last year of the study, indicating an increased frequency of complex cancer cases in the practice.…”

Section: Discussionsupporting

confidence: 58%

“…Other groups have reported on outcomes for high performing Whipple patients as a benchmark comparison for others, including minimally invasive PD (22). In their report, this center noted that 61 of 634 patients (9.6%) met the high performing criteria, and they concluded that minimally invasive PD should be held to this standard to this small subset of patients.…”

Section: Discussionmentioning

confidence: 99%

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Pancreaticoduodenectomy: minimizing the learning curve

Tsamalaidze¹,

Stauffer²

2018

J. Vis. Surg.

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Background: Pancreaticoduodenectomy outcomes improve as surgeon experience increases. We analyzed the outcomes of pancreaticoduodenectomy for any improvements over time to assess the learning curve.Methods: A retrospective study of patients undergoing consecutive pancreaticoduodenectomy by a single surgeon at the beginning of practice was performed. Operative factors and 90-day outcomes were examined and trends over the course of the 4-year time period were analyzed.Results: Between July 2011 and June 2015, 124 patients underwent pancreaticoduodenectomy (including total pancreatectomy, n=17) by open (n=93) or a laparoscopic (n=31) approach. The median operative time was 305 minutes which significantly improved over time. The median blood loss and length of stay were 250 mL and 6 days respectively which did not change over time. The pancreatic fistula rate, total morbidity, major morbidity, and mortality, and readmission rate was 7.5%, 41.1%, 14.5%, 1.6%, and 15.3% respectively and did not change over time. Pancreaticoduodenectomy was performed most commonly for pancreatic adenocarcinoma (51.6%) with a negative margin rate of 91.1% which significantly improved over time. Conclusions:The performance of pancreaticoduodenectomy improves as surgical experience is gained.However, a learning curve that impacts patient outcomes can be considerably diminished by appropriate training, high-volume practice/institution, proficient mentorship and experienced multidisciplinary team.

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“…To help decrease bias in the future, studies should focus on matching patients selected for MIS approaches to the best patients taken for open resection. 59 Until then, major conclusions regarding the impact and generalizability of this technology, especially for PD, remain to be determined and should remain in expert hands.…”

Section: Discussionmentioning

confidence: 99%

Minimally Invasive Pancreatectomy for Cancer: A Critical Review of the Current Literature

Place

Nau

Mezhir

2015

Journal of Gastrointestinal Surgery

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Minimally invasive surgery (MIS) has transformed operative practices by offering patients procedures with reduced hospital stay and recovery compared to that of open operations. In spite of the advantages of a MIS approach, the application to pancreatectomy has only recently emerged. This review aims to analyze and discuss available comparative studies as they relate to resection techniques for treatment of malignant disease. A PubMed search was used to obtain original studies and meta-analyses relating to MIS pancreatectomy from 2008 to 2013. Several studies were identified that reported on the application of MIS specifically to the treatment of cancer, many of which were retrospective, single-institution studies. Notwithstanding an inherent selection bias, several studies suggest that MIS can provide equivalent R0 resection rates, number of lymph nodes harvested, and survival to that of open resection. Furthermore, parameters such as blood loss and length of stay are significantly reduced in patients treated with MIS. The current literature supports the conclusion that MIS is safe and effective as a treatment for cancer in well-selected patients in the hands of experienced surgeons. However, the published studies to date are observational in nature and therefore higher quality studies will be needed to support the application and generalizability of MIS in the treatment of pancreatic malignancies.

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High Performing Whipple Patients: Factors Associated with Short Length of Stay after Open Pancreaticoduodenectomy

Cited by 44 publications

References 46 publications

Preoperative anemia is associated with increased use of hospital resources in patients undergoing elective hepatectomy

Preoperative anemia is associated with increased use of hospital resources in patients undergoing elective hepatectomy

Pancreaticoduodenectomy: minimizing the learning curve

Minimally Invasive Pancreatectomy for Cancer: A Critical Review of the Current Literature

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