Details

Autor(en) / Beteiligte

• McMillan, Matthew T
• Soi, Sameer
• Asbun, Horacio J
• Ball, Chad G
• Bassi, Claudio
• Beane, Joal D
• Behrman, Stephen W
• Berger, Adam C
• Bloomston, Mark
• Callery, Mark P
• Christein, John D
• Dixon, Elijah
• Drebin, Jeffrey A
• Castillo, Carlos Fernandez-Del
• Fisher, William E
• Fong, Zhi Ven
• House, Michael G
• Hughes, Steven J
• Kent, Tara S
• Kunstman, John W
• Malleo, Giuseppe
• Miller, Benjamin C
• Salem, Ronald R
• Soares, Kevin
• Valero, Vicente
• Wolfgang, Christopher L
• Vollmer, Jr, Charles M

Titel

Risk-adjusted Outcomes of Clinically Relevant Pancreatic Fistula Following Pancreatoduodenectomy: A Model for Performance Evaluation

Ist Teil von

• Annals of surgery, 2016-08, Vol.264 (2), p.344-352

Ort / Verlag

United States

Erscheinungsjahr

2016

Link zum Volltext

Quelle

MEDLINE

Beschreibungen/Notizen

• To evaluate surgical performance in pancreatoduodenectomy using clinically relevant postoperative pancreatic fistula (CR-POPF) occurrence as a quality indicator. Accurate assessment of surgeon and institutional performance requires (1) standardized definitions for the outcome of interest and (2) a comprehensive risk-adjustment process to control for differences in patient risk. This multinational, retrospective study of 4301 pancreatoduodenectomies involved 55 surgeons at 15 institutions. Risk for CR-POPF was assessed using the previously validated Fistula Risk Score, and pancreatic fistulas were stratified by International Study Group criteria. CR-POPF variability was evaluated and hierarchical regression analysis assessed individual surgeon and institutional performance. There was considerable variability in both CR-POPF risk and occurrence. Factors increasing the risk for CR-POPF development included increasing Fistula Risk Score (odds ratio 1.49 per point, P < 0.00001) and octreotide (odds ratio 3.30, P < 0.00001). When adjusting for risk, performance outliers were identified at the surgeon and institutional levels. Of the top 10 surgeons (≥15 cases) for nonrisk-adjusted performance, only 6 remained in this high-performing category following risk adjustment. This analysis of pancreatic fistulas following pancreatoduodenectomy demonstrates considerable variability in both the risk and occurrence of CR-POPF among surgeons and institutions. Disparities in patient risk between providers reinforce the need for comprehensive, risk-adjusted modeling when assessing performance based on procedure-specific complications. Furthermore, beyond inherent patient risk factors, surgical decision-making influences fistula outcomes.