Implementation of enhanced recovery after surgery for pancreatoduodenectomy increases the proportion of patients achieving textbook outcome: A retrospective cohort study

Lof, Sanne; Cacciaguerra, Andrea Benedetti; Al-Jarrah, R.; Okorocha, Chiemezie; Jaber, B.; Shamali, Awad; Clarke, Hannah F.; Armstrong, Thomas; Takhar, Arjun; Hamady, Zaed; Hilal, Mohammed Abu

doi:10.1016/j.pan.2020.05.018

Cited by 14 publications

(6 citation statements)

References 35 publications

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“…Therefore, there is potential value in using a cumulative analysis such as CuSum to monitor changes over time 5,20,21 . Studies have looked at using TO as a direct measure to assess outcomes after changes in standard care, such as introducing enhanced recovery surgery principles, but they have not utilized CuSum in conjunction with TO 22 . Having such data available may also be useful for counselling patients around peri‐operative risk.…”

Section: Discussionmentioning

confidence: 99%

Using Textbook Outcomes to benchmark practice in pancreatic surgery

Nicholas

Roessel

Burlet

et al. 2021

ANZ Journal of Surgery

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Background: Textbook Outcome (TO) is a novel composite measure of clinical outcomes that can be used to measure the quality of surgical outcomes. TOs for pancreatic surgery were published by the Dutch Pancreatic Cancer Group (DPCG) in 2020. The aim of this study was to explore how a medium volume hepatopancreaticobiliary unit could use TO to benchmark local outcomes following pancreatic surgery. Methods: Retrospective analysis of prospectively collected data from patients who underwent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) for all indications between March 2005 and February 2020 at Christchurch Hospital (CH). Analysis of TO items as defined by the DPCG was performed and compared to nationwide Dutch outcomes (2014-2017), including cumulative analysis using CuSum. Results: In total, 273 patients were included (median age 63 years; 51% female) of which 182 (67%) underwent PD and 91 (33%) underwent DP (median annual volume 12 PDs/6 DPs). Overall, 58% of patients undergoing PD and 74% of patients undergoing DP achieved TO, compared with 58% and 67%, P = 0.944 and P = 0.231, respectively, for the Netherlands (median annual volume 33 PDs/8 DPs per hospital). Conclusions: TO offers a useful quality measure to benchmark local outcomes following pancreatic surgery against an external nationwide analysis. The results show that as a medium volume centre performance was comparable to previously published Dutch results, which included high volume centres. Applying CuSum methodology to the TO metric allows a continuous measure of performance. This offers the potential to provide feedback for quality improvement strategies.

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Section: Discussionmentioning

confidence: 99%

Using Textbook Outcomes to benchmark practice in pancreatic surgery

Nicholas

Roessel

Burlet

et al. 2021

ANZ Journal of Surgery

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“…Female sex was an independent predictor of TO in patients undergoing HPB surgery both for cancer or any indication 8 , 15 , 27 , 28 . Omission of neoadjuvant chemotherapy in patients undergoing distal pancreatectomy, and a dilated pancreatic duct (more than 3 mm) as well as diagnosis of PDAC in patients receiving pancreatoduodenectomy were associated with higher likelihood of achieving TO 8 .…”

Section: Resultsmentioning

confidence: 93%

Textbook outcome in hepato-pancreato-biliary surgery: systematic review

et al. 2022

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Background Textbook outcome (TO) is a multidimensional measure reflecting the ideal outcome after surgery. As a benchmarking tool, it provides an objective overview of quality of care. Uniform definitions of TO in hepato-pancreato-biliary (HPB) surgery are missing. This study aimed to provide a definition of TO in HPB surgery and identify obstacles and predictors for achieving it. Methods A systematic literature search was conducted using PubMed, Embase, and Cochrane Database according to PRISMA guidelines. Studies published between 1993 and 2021 were retrieved. After selection, two independent reviewers extracted descriptive statistics and derived summary estimates of the occurrence of TO criteria and obstacles for achieving TO using co-occurrence maps. Results Overall, 30 studies were included. TO rates ranged between 16–69 per cent. Commonly chosen co-occurring criteria to define TO included ‘no prolonged length of stay (LOS)’, ‘no complications’, ‘no readmission’, and ‘no deaths’. Major obstacles for achieving TO in HPB surgery were prolonged LOS, complications, and readmission. On multivariable analysis, TO predicted better overall and disease-free survival in patients with cancer. Achievement of TO was more likely in dedicated centres and associated with procedural and structural indicators, including high case-mix index and surgical volume. Conclusion TO is a useful quality measure to benchmark surgical outcome. Future definitions of TO in HPB surgery should include ‘no prolonged LOS’, ‘no complications’, ‘no readmission’, and ‘no deaths’.

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“…Of 1160 studies identified in the literature search 15 studies comprising IPD of 1109 patients were included (Figure 1 and Table S1). 11,[19][20][21][22][23][24][25][26][27][28][29][30][31][32] All studies were single-center. Data from 14 studies could not be obtained as these data were no longer available in these centers and two studies did not provide patient age.…”

Section: Resultsmentioning

confidence: 99%

Are enhanced recovery protocols after pancreatoduodenectomy still efficient when applied in elderly patients? A systematic review and individual patient data meta‐analysis

Kuemmerli,

Balzano,

Bouwense

et al. 2024

J Hepato Biliary Pancreat

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BackgroundThis meta‐analysis investigated the effects of enhanced recovery after surgery (ERAS) protocols compared to conventional care on postoperative outcomes in patients aged 70 years or older undergoing pancreatoduodenectomy (PD).MethodsFive databases were systematically searched. Comparative studies with available individual patient data (IPD) were included. The main outcomes were postoperative morbidity, length of stay, readmission and postoperative functional recovery elements. To assess an age‐dependent effect, the group was divided in septuagenarians (70–79 years) and older patients (≥80 years).ResultsIPD were obtained from 15 of 31 eligible studies comprising 1109 patients. The overall complication and major complication rates were comparable in both groups (OR 0.92 [95% CI: 0.65–1.29], p = .596 and OR 1.22 [95% CI: 0.61–2.46], p = .508). Length of hospital stay tended to be shorter in the ERAS group compared to the conventional care group (−0.14 days [95% CI: −0.29 to 0.01], p = .071) while readmission rates were comparable and the total length of stay including days in hospital after readmission tended to be shorter in the ERAS group (−0.28 days [95% CI: −0.62 to 0.05], p = .069). In the subgroups, the length of stay was shorter in octogenarians treated with ERAS (−0.36 days [95% CI: −0.71 to −0.004], p = .048). The readmission rate increased slightly but not significantly while the total length of stay was not longer in the ERAS group.ConclusionERAS in the elderly is safe and its benefits are preserved in the care of even in patients older than 80 years. Standardized care protocol should be encouraged in all pancreatic centers.

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Implementation of enhanced recovery after surgery for pancreatoduodenectomy increases the proportion of patients achieving textbook outcome: A retrospective cohort study

Cited by 14 publications

References 35 publications

Using Textbook Outcomes to benchmark practice in pancreatic surgery

Using Textbook Outcomes to benchmark practice in pancreatic surgery

Textbook outcome in hepato-pancreato-biliary surgery: systematic review

Are enhanced recovery protocols after pancreatoduodenectomy still efficient when applied in elderly patients? A systematic review and individual patient data meta‐analysis

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