Defining Benchmark Outcomes for Distal Pancreatectomy

Durin, Thibault; Marchese, Ugo; Sauvanet, Alain; Dokmak, Safi; Cherkaoui, Zineb; Fuks, David; Laurent, Césari; André, Marie; Ayav, Ahmet; Magallon, Cloé; Turrini, Olivıer; Sulpice, Laurent; Robin, Fabien; Bachellier, Philippe; Addeo, P.; Souche, Régis; Bardol, T.; Périnel, Julie; Adham, Mustapha; Tzedakis, Stylianos; Birnbaum, David; Facy, Olivier; Gagnière, Johan; Gaujoux, Sébastien; Tribillon, Ecoline; Roussel, Edouard; Schwarz, L.; Barbier, Louise; Doussot, Alexandre; Régenet, Nicolas; Iannelli, Antonio; Régimbeau, Jean‐Marc; Piessen, Guillaume; Lenne, X.; Truant, Stéphanie; Amrani, Mehdi El

doi:10.1097/sla.0000000000005539

Cited by 17 publications

(11 citation statements)

References 33 publications

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“… 6 , postoperative safety outcomes from the current meta-analysis appear within benchmark cut-offs. Recently published analyses further report benchmark criteria for minimally invasive and open DP 38 , 43 , 44 . Benchmark cut-off values for mortality rate in PD were set at less than or equal to 1.6 per cent and 2 per cent by Sánchez-Velázquez et al .…”

Section: Discussionmentioning

confidence: 99%

Minimally invasiveversusopen pancreatic surgery: meta-analysis of randomized clinical trials

et al. 2023

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Background Widespread implementation of the minimally invasive technique in pancreatic surgery has proven to be challenging. The aim of this study was to compare the perioperative outcomes of minimally invasive (laparoscopic and robotic) pancreatic surgery with open pancreatic surgery using data obtained from RCTs. Methods A literature search was done using Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, and Web of Science; all available RCTs comparing minimally invasive pancreatic surgery and open pancreatic surgery in adults requiring elective distal pancreatectomy or partial pancreatoduodenectomy were included. Outcomes were mortality rate, general and pancreatic surgery specific morbidity rate, and length of hospital stay. Results Six RCTs with 984 patients were included; 99.0 per cent (486) of minimally invasive procedures were performed laparoscopically and 1.0 per cent (five) robotically. In minimally invasive pancreatic surgery, length of hospital stay (−1.3 days, −2 to −0.5, P = 0.001) and intraoperative blood loss (−137 ml, −182 to −92, P < 0.001) were reduced. In the subgroup analysis, reduction in length of hospital stay was only present for minimally invasive distal pancreatectomy (−2 days, −2.3 to −1.7, P < 0.001). A minimally invasive approach showed reductions in surgical site infections (OR 0.4, 0.1 to 0.96, P = 0.040) and intraoperative blood loss (−131 ml, −173 to −89, P < 0.001) with a 75 min longer duration of surgery (42 to 108 min, P < 0.001) only in partial pancreatoduodenectomy. No significant differences were found with regards to mortality rate and postoperative complications. Conclusion This meta-analysis presents level 1 evidence of reduced length of hospital stay and intraoperative blood loss in minimally invasive pancreatic surgery compared with open pancreatic surgery. Morbidity rate and mortality rate were comparable, but longer duration of surgery in minimally invasive partial pancreatoduodenectomy hints that this technique in partial pancreatoduodenectomy is technically more challenging than in distal pancreatectomy.

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Section: Discussionmentioning

confidence: 99%

Minimally invasiveversusopen pancreatic surgery: meta-analysis of randomized clinical trials

et al. 2023

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“…Hospital readmission is currently considered a measure of health care quality in patients undergoing pancreatectomy. 31,32 Two recent studies that focused on the benchmark analysis of PD and DP considered hospital readmission as a metric to define the best postoperative outcomes. However, some authors have reported that readmission may not always correlate with the quality of care.…”

Section: Discussionmentioning

confidence: 99%

Study of Risk Factors for Readmission After Pancreatectomy for Cancer

et al. 2023

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Objective: To identify the factors associated with readmission after pancreatectomy for cancer and to assess their impact on the 1-year mortality in a French multicentric population. Background: Pancreatectomy is a complex procedure with high morbidity that increases the length of hospital stay and jeopardizes survival. Hospital readmissions lead to increased health system costs, making this a topic of great interest. Methods: Data collected from patients who underwent pancreatectomy for cancer between 2011 and 2019 were extracted from a French national medico-administrative database. A descriptive analysis was conducted to evaluate the association of baseline variables, including age, sex, liverrelated comorbidities, Charlson Comorbidity Index, tumor localization, and use of neoadjuvant therapy, along with hospital type and volume, with readmission status. Centers were divided into low and high volumes according to the cutoff of 26 cases/year. Logistic regression models were developed to determine whether the identified bivariate associations persisted after adjusting for the patient characteristics. The mortality rates during readmission and at 1 year postoperatively were also determined. Results: Of 22,935 patients who underwent pancreatectomy, 9129 (39.3%) were readmitted within 6 months. Readmission rates by year did not vary over the study period, and mean readmissions occurred within 20 days after discharge. Multivariate analysis showed that male sex [odds ratio (OR) = 1.12], age > 70 years (OR = 1.16), comorbidities (OR = 1.21), distal pancreatectomy (OR = 1.11), and major postoperative complications (OR = 1.37) were predictors of readmission. Interestingly, readmission and surgery in low-volume centers increased the risk of death at 1 year by a factor of 2.15 [(2.01-2.31), P < 0.001] and 1.31 [(1.17-1.47), P < 0.001], respectively.Conclusions: Readmission after pancreatectomy for cancer is high with an increased rate of 1-year mortality.

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Section: Introductionmentioning

confidence: 99%

“…Accordingly, benchmarks have already been established for breast 3 , liver [4][5][6][7][8] , oesophageal 9 , and pancreatic [10][11][12][13] surgery. For pancreatic surgery, benchmarks have only been applied to open pancreatoduodenectomy 10,11 , open distal pancreatectomy 12 or minimally invasive distal pancreatectomy with splenectomy 13 , and none have been defined for spleen-preserving distal pancreatectomy (SPDP). As previous comparative studies [14][15][16][17][18] between distal pancreatectomy with and without splenectomy have reported significant differences in intraoperative and postoperative outcomes, separate benchmarks are required for the two procedures.…”

Section: Introductionmentioning

confidence: 99%

Benchmarking of robotic and laparoscopic spleen-preserving distal pancreatectomy by using two different methods

Ramshorst

Giani

Mazzola

et al. 2022

British Journal of Surgery

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Background Benchmarking is an important tool for quality comparison and improvement. However, no benchmark values are available for minimally invasive spleen-preserving distal pancreatectomy, either laparoscopically or robotically assisted. The aim of this study was to establish benchmarks for these techniques using two different methods. Methods Data from patients undergoing laparoscopically or robotically assisted spleen-preserving distal pancreatectomy were extracted from a multicentre database (2006–2019). Benchmarks for 10 outcomes were calculated using the Achievable Benchmark of Care (ABC) and best-patient-in-best-centre methods. Results Overall, 951 laparoscopically assisted (77.3 per cent) and 279 robotically assisted (22.7 per cent) procedures were included. Using the ABC method, the benchmarks for laparoscopically assisted and robotically assisted spleen-preserving distal pancreatectomy respectively were: 150 and 207 min for duration of operation, 55 and 100 ml for blood loss, 3.5 and 1.7 per cent for conversion, 0 and 1.7 per cent for failure to preserve the spleen, 27.3 and 34.0 per cent for overall morbidity, 5.1 and 3.3 per cent for major morbidity, 3.6 and 7.1 per cent for pancreatic fistula grade B/C, 5 and 6 days for duration of hospital stay, 2.9 and 5.4 per cent for readmissions, and 0 and 0 per cent for 90-day mortality. Best-patient-in-best-centre methodology revealed milder benchmark cut-offs for laparoscopically and robotically assisted procedures, with operating times of 254 and 262.5 min, blood loss of 150 and 195 ml, conversion rates of 5.8 and 8.2 per cent, rates of failure to salvage spleen of 29.9 and 27.3 per cent, overall morbidity rates of 62.7 and 55.7 per cent, major morbidity rates of 20.4 and 14 per cent, POPF B/C rates of 23.8 and 24.2 per cent, duration of hospital stay of 8 and 8 days, readmission rates of 20 and 15.1 per cent, and 90-day mortality rates of 0 and 0 per cent respectively. Conclusion Two benchmark methods for minimally invasive distal pancreatectomy produced different values, and should be interpreted and applied differently.

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Defining Benchmark Outcomes for Distal Pancreatectomy

Cited by 17 publications

References 33 publications

Minimally invasiveversusopen pancreatic surgery: meta-analysis of randomized clinical trials

Minimally invasiveversusopen pancreatic surgery: meta-analysis of randomized clinical trials

Study of Risk Factors for Readmission After Pancreatectomy for Cancer

Benchmarking of robotic and laparoscopic spleen-preserving distal pancreatectomy by using two different methods

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