J Annelie Suurmeijer1,2, Anne Claire Henry3, Bert A Bonsing4, Koop Bosscha5, Ronald M van Dam6, Casper H van Eijck7, Michael F Gerhards8, Erwin van der Harst9, Ignace H de Hingh10, Martijn P Intven11, Geert Kazemier2,12, Johanna W Wilmink2,13, Daan J Lips14, Fennie Wit15, Vincent E de Meijer16, I Quintus Molenaar3, Gijs A Patijn17, George P van der Schelling18, Martijn W J Stommel19, Olivier R Busch1,2, Bas Groot Koerkamp4, Hjalmar C van Santvoort3, Marc G Besselink1,2. 1. Amsterdam UMC, location University of Amsterdam, Department of surgery, Amsterdam, the Netherlands. 2. Cancer Center Amsterdam, the Netherlands. 3. Department of Surgery, Regional Academic Cancer Center Utrecht, St. Antonius Hospital and University Medical Center Utrecht the Netherlands. 4. Department of Surgery, Leiden University Medical Center. 5. Department of surgery, Jeroen Bosch ziekenhuis, Den Bosch, the Netherlands. 6. Department of surgery, Maastricht University Medical Center, Maastricht, the Netherlands, & University Hospital RWTH Aachen, Aachen, Germany. 7. Department of surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands. 8. Department of Surgery, OLVG, Amsterdam, the Netherlands. 9. Department of Surgery, Maasstadziekenhuis, Rotterdam, the Netherlands. 10. Department of Surgery, Catharina Cancer Institute, Eindhoven, the Netherlands. 11. Department of Radiation Oncology, University Medical Center Utrecht, Utrecht. 12. Amsterdam UMC, location Vrije Universiteit, Department of surgery, Amsterdam, the Netherlands. 13. Amsterdam UMC, location University of Amsterdam, Department of Medical Oncology, Amsterdam, the Netherlands. 14. Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands. 15. Department of Surgery, Tjongerschans hospital, Heerenveen, the Netherlands. 16. Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands. 17. Department of Surgery, Isala Clinics, Zwolle, the Netherlands. 18. Department of Surgery, Amphia Hospital, Breda, the Netherlands. 19. Department of Surgery, Radboud University Medical Center Nijmegen, the Netherlands.
Abstract
OBJECTIVE: To describe outcome after pancreatic surgery in the first six years of a mandatory nationwide audit. BACKGROUND: Within the Dutch Pancreatic Cancer Group, efforts have been made to improve outcome after pancreatic surgery. These include collaborative projects, clinical auditing, and implementation of an algorithm for early recognition and management of postoperative complications. However, nationwide changes in outcome over time have not yet been described. METHODS: This nationwide cohort study included consecutive patients after pancreatoduodenectomy and distal pancreatectomy from the mandatory Dutch Pancreatic Cancer Audit (January 2014-December 2019). Patient, tumor, and treatment characteristics were compared between three time periods (2014-2015, 2016-2017, and 2018-2019). Short-term surgical outcome was investigated using multilevel multivariable logistic regression analyses. Primary endpoints were failure to rescue and in-hospital mortality. RESULTS: Overall, 5345 patients were included, of whom 4227 after pancreatoduodenectomy and 1118 after distal pancreatectomy. After pancreatoduodenectomy, failure to rescue improved from 13% to 7.4% (OR 0.64, 95%CI 0.50-0.80, P<0.001) and in-hospital mortality decreased from 4.1% to 2.4% (OR 0.68, 95%CI 0.54-0.86, P=0.001), despite operating on more patients with age >75 years (18% to 22%, P=0.006), ASA score ≥3 (19% to 31%, P<0.001) and Charlson comorbidity score ≥2 (24% to 34%, P<0.001). The rates of textbook outcome (57% to 55%, P=0.283) and major complications remained stable (31% to 33%, P=0.207), whereas complication-related intensive care admission decreased (13% to 9%, P=0.002). After distal pancreatectomy, improvements in failure to rescue from 8.8% to 5.9% (OR 0.65, 95%CI 0.30-1.37, P=0.253) and in-hospital mortality from 1.6% to 1.3% (OR 0.88, 95%CI 0.45-1.72, P=0.711) were not statistically significant. CONCLUSIONS: During the first six years of a nationwide audit, in-hospital mortality and failure to rescue after pancreatoduodenectomy improved despite operating on more high-risk patients. Several collaborative efforts may have contributed to these improvements.
OBJECTIVE: To describe outcome after pancreatic surgery in the first six years of a mandatory nationwide audit. BACKGROUND: Within the Dutch Pancreatic Cancer Group, efforts have been made to improve outcome after pancreatic surgery. These include collaborative projects, clinical auditing, and implementation of an algorithm for early recognition and management of postoperative complications. However, nationwide changes in outcome over time have not yet been described. METHODS: This nationwide cohort study included consecutive patients after pancreatoduodenectomy and distal pancreatectomy from the mandatory Dutch Pancreatic Cancer Audit (January 2014-December 2019). Patient, tumor, and treatment characteristics were compared between three time periods (2014-2015, 2016-2017, and 2018-2019). Short-term surgical outcome was investigated using multilevel multivariable logistic regression analyses. Primary endpoints were failure to rescue and in-hospital mortality. RESULTS: Overall, 5345 patients were included, of whom 4227 after pancreatoduodenectomy and 1118 after distal pancreatectomy. After pancreatoduodenectomy, failure to rescue improved from 13% to 7.4% (OR 0.64, 95%CI 0.50-0.80, P<0.001) and in-hospital mortality decreased from 4.1% to 2.4% (OR 0.68, 95%CI 0.54-0.86, P=0.001), despite operating on more patients with age >75 years (18% to 22%, P=0.006), ASA score ≥3 (19% to 31%, P<0.001) and Charlson comorbidity score ≥2 (24% to 34%, P<0.001). The rates of textbook outcome (57% to 55%, P=0.283) and major complications remained stable (31% to 33%, P=0.207), whereas complication-related intensive care admission decreased (13% to 9%, P=0.002). After distal pancreatectomy, improvements in failure to rescue from 8.8% to 5.9% (OR 0.65, 95%CI 0.30-1.37, P=0.253) and in-hospital mortality from 1.6% to 1.3% (OR 0.88, 95%CI 0.45-1.72, P=0.711) were not statistically significant. CONCLUSIONS: During the first six years of a nationwide audit, in-hospital mortality and failure to rescue after pancreatoduodenectomy improved despite operating on more high-risk patients. Several collaborative efforts may have contributed to these improvements.
Authors: Martin Wagner; Johanna M Brandenburg; Sebastian Bodenstedt; André Schulze; Alexander C Jenke; Antonia Stern; Marie T J Daum; Lars Mündermann; Fiona R Kolbinger; Nithya Bhasker; Gerd Schneider; Grit Krause-Jüttler; Hisham Alwanni; Fleur Fritz-Kebede; Oliver Burgert; Dirk Wilhelm; Johannes Fallert; Felix Nickel; Lena Maier-Hein; Martin Dugas; Marius Distler; Jürgen Weitz; Beat-Peter Müller-Stich; Stefanie Speidel Journal: Surg Endosc Date: 2022-09-28 Impact factor: 3.453
Authors: Myrte Gorris; Nadine C M van Huijgevoort; Arantza Farina; Lodewijk A A Brosens; Hjalmar C van Santvoort; Bas Groot Koerkamp; Marco J Bruno; Marc G Besselink; Jeanin E van Hooft Journal: Cancers (Basel) Date: 2022-08-30 Impact factor: 6.575