Textbook Outcome

Abstract

for the Dutch Pancreatic Cancer Group Background: Textbook outcome (TO) is a multidimensional measure for quality assurance, reflecting the ''ideal'' surgical outcome. Methods: Post-hoc analysis of patients who underwent pancreatoduodenectomy (PD) or distal pancreatectomy (DP) for all indications between 2014 and 2017, queried from the nationwide prospective Dutch Pancreatic Cancer Audit. An international survey was conducted among 24 experts from 10 countries to reach consensus on the requirements for TO in pancreatic surgery. Univariable and multivariable logistic regression was performed to identify TO predictors. Between-hospital variation in TO rates was compared using observed-versus-expected rates. Results: Based on the survey (92% response rate), TO was defined by the absence of postoperative pancreatic fistula, bile leak, postpancreatectomy hemorrhage (all ISGPS grade B/C), severe complications (Clavien-Dindo !III), readmission, and in-hospital mortality. Overall, 3341 patients were included (2633 (79%) PD and 708 (21%) DP) of whom 60.3% achieved TO; 58.3% for PD and 67.4% for DP. On multivariable analysis, ASA class 3 predicted a worse TO rate after PD (ASA 3 OR 0.59 [0.44-0.80]), whereas a dilated pancreatic duct (>3 mm) and pancreatic ductal adenocarcinoma (PDAC) were associated with a better TO rate (OR 2.22 [2.05-3.57] and OR 1.36 [1.14-1.63], respectively). For DP, female sex and the absence of neoadjuvant therapy predicted better TO rates (OR 1.38 [1.01-1.90] and OR 2.53 [1.20-5.31], respectively). When comparing institutions, the observedversus-expected rate for achieving TO varied from 0.71 to 1.46 per hospital after casemix-adjustment. Conclusions: TO is a novel quality measure in pancreatic surgery. TO varies considerably between pancreatic centers, demonstrating the potential benefit of quality assurance programs.

Safe implementation of minimally invasive pancreas resection: a systematic review

“…Several authors have used various 'text book outcomes' for quality assessment in healthcare. [58][59][60][61][62][63] The use of a 'textbook outcome' has also been described for pancreatic surgery specifically, 64,65 as well as for the assessment of the learning curve of minimally invasive esophagectomy. 66 Future research regarding the learning curve of MIPR should preferably use such a, predefined, composite outcome, including morbidity to increase clinical relevance.…”

Predicting Outcomes in Patients Undergoing Pancreatectomy Using Wearable Technology and Machine Learning: Prospective Cohort Study (Preprint)

“…All postoperative complications and readmissions were collected for 30 days after hospital discharge. Complications data were then used to compute the primary outcome for our study-the textbook outcome for pancreatectomy [27]. Textbook outcome was defined as the absence of postoperative pancreatic fistulae, bile leak, postpancreatectomy hemorrhage, severe complications, readmission, and in-hospital mortality.…”

Patient Perspectives on Defining Textbook Outcomes Following Major Abdominal Surgery

“…[6][7][8][9] In this context, recent research has focused on the novel composite metric known as a "textbook outcome" (TO) to describe when all desired perioperative outcomes have been met. 4,5,[10][11][12][13][14][15][16][17][18][19] Since a TO includes the most important outcome parameters of the surgical process, it provides an objective overview of the overall quality of care.…”