Using Textbook Outcomes to benchmark practice in pancreatic surgery

Nicholas, Ella; Roessel, Stijn van; Burlet, Kirsten J. de; Hore, Todd; Besselink, Marc G.; Connor, Saxon

doi:10.1111/ans.16555

Cited by 16 publications

(22 citation statements)

References 22 publications

(53 reference statements)

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“…The CCS patients had a similar PD proportion when compared to the patients of HVAS (Table 2 ; Additional file 1 ) [ 10 – 12 , 14 – 16 ]. The CCS patients had a similar DP proportion when compared to the patients of HVAS (Table 2 ; Additional file 1 ) [ 10 – 12 , 14 – 16 ]. The CCS patients had a significantly higher ASA ≥ 3 proportion than the patients of HVAS (Table 2 ; Additional file 2 ) [ 11 , 12 , 15 , 16 ].…”

Section: Resultsmentioning

confidence: 99%

“…The CCS patients had a similar DGE proportion compared to the patients of HVAS (Table 2 ; Additional file 7 ) [ 10 – 13 , 15 , 16 ]. The CCS patients had a lower CD III–IV proportion than the patients of HVAS (Table 2 ; Additional file 8 ) [ 11 , 12 , 14 ]. The CCS patients had a similar readmission proportion compared to the patients of HVAS (Table 2 ; Additional file 9 ) [ 10 , 12 , 14 ].…”

Section: Resultsmentioning

confidence: 99%

“…The CCS patients had a lower CD III–IV proportion than the patients of HVAS (Table 2 ; Additional file 8 ) [ 11 , 12 , 14 ]. The CCS patients had a similar readmission proportion compared to the patients of HVAS (Table 2 ; Additional file 9 ) [ 10 , 12 , 14 ]. Test results for HVAS proportion heterogeneity and total proportion values are included in Additional files 1 , 2 , 3 , 4 , 5 , 6 , 7 , 8 , 9 .…”

Section: Resultsmentioning

confidence: 99%

Section: All Pancreatic Surgical Patientsmentioning

confidence: 99%

“…The literature search found seven relevant mixed pancreatic surgical citations from HVAS [10][11][12][13][14][15][16]. The CCS patients had a similar PD proportion when compared to the patients of HVAS (Table 2; Additional file 1) [10][11][12][14][15][16]. The CCS patients had a similar DP proportion when compared to the patients of HVAS (Table 2; Additional file 1) [10][11][12][14][15][16].…”

Section: All Pancreatic Surgical Patientsmentioning

confidence: 99%

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Establishing an open and robotic pancreatic surgery program in a level 1 trauma center community teaching hospital and comparing its outcomes to high-volume academic center outcomes: a retrospective review

et al. 2022

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Background The debate of whether to centralize hepato-pancreato-biliary surgery has been ongoing. The principal objective was to compare outcomes of a community pancreatic surgical program with those of high-volume academic centers. Methods The current pancreatic surgical study occurred in an environment where (1) a certified abdominal transplant surgeon performed all surgeries; (2) complementary quality enhancement programs had been developed; (3) the hospital’s trauma center had been verified; and (4) the hospital’s surgical training had been accredited. Pancreatic surgical outcomes at high-volume academic centers were obtained through PubMed literature searches. Articles were selected if they described diverse surgical procedures. Two-tailed Fisher exact and mid-P tests were used to perform 2 × 2 contingency analyses. Results The study patients consisted of 64 consecutive pancreatic surgical patients. The study patients had a similar pancreaticoduodenectomy proportion (59.4%) when compared to literature patients (66.8%; P = 0.227). The study patients also had a similar distal pancreatectomy proportion (25.0%) when compared to literature patients (31.9%; P = 0.276). The study patients had a significantly higher American Society of Anesthesiologists physical status ≥ 3 proportion (100%) than literature patients (28.1%; P < 0.001). The 90-day study mortality proportion (0%) was similar to the literature proportion (2.3%; P = 0.397). The study postoperative pancreatic fistula proportion was lower (3.2%), when compared to the literature proportion (18.4%; P < 0.001; risk ratio = 5.8). The study patients had a lower reoperation proportion (3.1%) than the literature proportion (8.7%; mid-P = 0.051; risk ratio = 2.8). The study patients had a lower surgical site infection proportion (3.1%) than those in the literature (21.1%; P < 0.001; risk ratio = 6.8). The study patients had equivalent delayed gastric emptying (15.6%) when compared to literature patients (10.6%; P = 0.216). The study patients had decreased Clavien–Dindo grades III–IV complications (10.9%) compared to the literature patients (21.8%; mid-P = 0.018). Lastly, the study patients had a similar readmission proportion (20.3%) compared to literature patients (18.4%; P = 0.732). Conclusion Despite pancreatic surgical patients having greater preoperative medical comorbidities, the current community study outcomes were comparable to or better than high-volume academic center results.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: All Pancreatic Surgical Patientsmentioning

confidence: 99%

Section: All Pancreatic Surgical Patientsmentioning

confidence: 99%

See 3 more Smart Citations

Establishing an open and robotic pancreatic surgery program in a level 1 trauma center community teaching hospital and comparing its outcomes to high-volume academic center outcomes: a retrospective review

et al. 2022

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Textbook outcome as a composite measure of quality in hepaticopancreatic surgery

Mohamed,

Nicolais,

Fitzgerald

2023

J Hepato Biliary Pancreat

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BackgroundTextbook outcome (TO) is a valuable metric to assess postoperative outcomes. The aim of this study was to assess TO in patients undergoing hepatopancreatic surgery.MethodsThis was a retrospective cohort NSQIP study from 2015 to 2018. TOs are defined as no complication or mortality and length of stay within the 75th percentile.ResultsThis study included 44 235 patients. Of those patients, 61% underwent pancreatic surgery (PS) and 39% hepatic surgery (HS). The most common surgical procedure was pancreaticoduodenectomy (16 464), followed by partial hepatectomy (11 817), distal pancreatectomy (8292), hemihepatectomy (4247), hepatic trisegmentectomy (1366) and total pancreatectomy (706). TO was more common for HS than PS, 47% versus 40%, p < .001. TO was more common for younger (0–65, OR: 1.60; CI: 1.30–1.96, p < .001), female (OR: 1.23; CI: 1.17–1.29, p < .001), white (OR: 1.10; CI: 1.01–1.19, p = .022), and lower ASA class (OR: 2.11; CI: 1.54–2.90, p < .001) patients. For patients undergoing HS TO was more common after partial lobectomy than trisegmentectomy and lobectomy (OR: 1.36; CI: 1.18–1.57, p < .001). For those undergoing PS, there was a lower likelihood of TO for those who are obese/morbidly obese compared to normal‐weight patients (OR: 0.73; CI: 0.67–0.79, p < .001). Unlike HS, TO for patients undergoing PS was not associated with the type of surgical procedure.ConclusionsTO is a composite that can be applied to a national data set to analyze outcome quality. In HS, more complex surgical procedures are associated with a decreased likelihood of TO. In PS, TO are similar regardless of the procedure but less common in obese or morbidly obese patients.

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Defining a textbook outcome for the resection of colorectal liver metastases

Neary

O’Brien

McCormack

et al. 2022

Journal of Surgical Oncology

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Introduction Textbook outcomes (TBO) are composite measures of care which may be superior in assessing quality compared to traditional methods. We aim to define TBO which are specific to surgical resection of colorectal liver metastases, and investigate their impact on survival. Methods Single center analysis of all liver resections performed at our center from 2009 to 2020. A Cox model was used to identify perioperative outcomes which impacted on overall survival. These were retained with important postoperative outcomes to form a “TBO.” The impact of a TBO on overall survival was investigated using Kaplan−Meier curve analysis. Results TBO was achieved in 72.2% (197/273) of resections. Major morbidity (Clavien−Dindo ≥3) at 19.4% was the major limiting factor in not achieving a TBO. TBO was associated with improved 3‐year (77% vs. 55%), 5‐year (60.7% vs. 42.5%), and median (93 vs. 44 months) overall survival (log‐rank test, p = 0.006). Multivariable analysis revealed age >65 years, American Society of Anaesthesiologists Grade III–IV, and resection of >2 segments as factors predictive of not achieving a TBO. Conclusion TBO is a useful composite measure in surgery for colorectal liver metastases. It can highlight areas which may be targeted for quality improvement and be useful as a tool to examine variation between centers. Achieving a TBO is associated with a significant improvement in survival.

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Using Textbook Outcomes to benchmark practice in pancreatic surgery

Cited by 16 publications

References 22 publications

Establishing an open and robotic pancreatic surgery program in a level 1 trauma center community teaching hospital and comparing its outcomes to high-volume academic center outcomes: a retrospective review

Establishing an open and robotic pancreatic surgery program in a level 1 trauma center community teaching hospital and comparing its outcomes to high-volume academic center outcomes: a retrospective review

Textbook outcome as a composite measure of quality in hepaticopancreatic surgery

Defining a textbook outcome for the resection of colorectal liver metastases

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