Sjors Klompmaker1,2, Walderik J van der Vliet1,3, Stijn J Thoolen1, Ana Sofia Ore1, Koen Verkoulen1,3, Monica Solis-Velasco1, Elena G Canacari4, Jonathan B Kruskal5, Khalid O Khwaja6, Jennifer F Tseng7, Mark P Callery1, Tara S Kent1, A James Moser1. 1. Beth Israel Deaconess Medical Center, Harvard Medical School, Pancreas and Liver Institute, Boston, MA. 2. Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. 3. Department of Surgery, Maastricht University Medical Center, Maastricht University, Maastricht, The Netherlands. 4. Department of Nursing, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 5. Medical Executive Committee, Beth Israel Deaconess Medical Center, Boston, MA. 6. The Transplant Center, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA. 7. Department of Surgery, Boston Medical Center, Boston University, Boston, MA.
Abstract
OBJECTIVE: To train practicing surgeons in robot-assisted distal pancreatectomy (RADP) and assess the impact on 5 domains of healthcare quality. BACKGROUND: RADP may reduce the treatment burden compared with open distal pancreatectomy (ODP), but studies on institutional training and implementation programs are scarce. METHODS: A retrospective, single-center, cohort study evaluating surgical performance during a procedure-specific training program for RADP (January 2006 to September 2017). Baseline and unadjusted outcomes were compared "before training" (ODP only; <June 2012) and "after training" (RADP and ODP; >June 2012). Exclusion criteria were neoadjuvant therapy, vascular- and unrelated organ resection. Run charts evaluated index length of stay (LOS) and 90-day comprehensive complication index. Cumulative sum charts of operating time (OT) assessed institutional learning. Adjusted outcomes after RADP versus ODP were compared using a secondary propensity-score-matched (1:1) analysis to determine clinical efficacy. RESULTS: After screening, 237 patients were included in the before-training (133 ODP) and after-training (24 ODP, 80 RADP) groups. After initiation of training, mean perioperative blood loss decreased (-255 mL, P<0.001), OT increased (+65 min, P < 0.001), and median LOS decreased (-1 day, P < 0.001). All other outcomes remained similar (P>0.05). Over time, there were nonrandom (P < 0.05) downward shifts in LOS, while comprehensive complication index was unaffected. We observed 3 learning curve phases in OT: accumulation (<31 cases), optimization (case 31-65), and a steady-state (>65 cases). Propensity-score-matching confirmed reductions in index and 90-day LOS and blood loss with similar morbidity between RADP and ODP. CONCLUSION: Supervised procedure-specific training enabled successful implementation of RADP by practicing surgeons with immediate improvements in length of stay, without adverse effects on safety.
OBJECTIVE: To train practicing surgeons in robot-assisted distal pancreatectomy (RADP) and assess the impact on 5 domains of healthcare quality. BACKGROUND: RADP may reduce the treatment burden compared with open distal pancreatectomy (ODP), but studies on institutional training and implementation programs are scarce. METHODS: A retrospective, single-center, cohort study evaluating surgical performance during a procedure-specific training program for RADP (January 2006 to September 2017). Baseline and unadjusted outcomes were compared "before training" (ODP only; <June 2012) and "after training" (RADP and ODP; >June 2012). Exclusion criteria were neoadjuvant therapy, vascular- and unrelated organ resection. Run charts evaluated index length of stay (LOS) and 90-day comprehensive complication index. Cumulative sum charts of operating time (OT) assessed institutional learning. Adjusted outcomes after RADP versus ODP were compared using a secondary propensity-score-matched (1:1) analysis to determine clinical efficacy. RESULTS: After screening, 237 patients were included in the before-training (133 ODP) and after-training (24 ODP, 80 RADP) groups. After initiation of training, mean perioperative blood loss decreased (-255 mL, P<0.001), OT increased (+65 min, P < 0.001), and median LOS decreased (-1 day, P < 0.001). All other outcomes remained similar (P>0.05). Over time, there were nonrandom (P < 0.05) downward shifts in LOS, while comprehensive complication index was unaffected. We observed 3 learning curve phases in OT: accumulation (<31 cases), optimization (case 31-65), and a steady-state (>65 cases). Propensity-score-matching confirmed reductions in index and 90-day LOS and blood loss with similar morbidity between RADP and ODP. CONCLUSION: Supervised procedure-specific training enabled successful implementation of RADP by practicing surgeons with immediate improvements in length of stay, without adverse effects on safety.
Authors: Sneha Rajiv Jain; Wilson Sim; Cheng Han Ng; Yip Han Chin; Wen Hui Lim; Nicholas L Syn; Nur Haidah Bte Ahmad Kamal; Mehek Gupta; Valerie Heong; Xiao Wen Lee; Nur Sabrina Sapari; Xue Qing Koh; Zul Fazreen Adam Isa; Lucius Ho; Caitlin O'Hara; Arvindh Ulagapan; Shi Yu Gu; Kashyap Shroff; Rei Chern Weng; Joey S Y Lim; Diana Lim; Brendan Pang; Lai Kuan Ng; Andrea Wong; Ross Andrew Soo; Wei Peng Yong; Cheng Ean Chee; Soo-Chin Lee; Boon-Cher Goh; Richie Soong; David S P Tan Journal: Front Oncol Date: 2021-09-24 Impact factor: 6.244