Outcome of Pancreatic Surgery During the First Six Years of a Mandatory Audit within the Dutch Pancreatic Cancer Group

J Annelie Suurmeijer; Anne Claire Henry; Bert A Bonsing; Koop Bosscha; Ronald M van Dam; Casper H van Eijck; Michael F Gerhards; Erwin van der Harst; Ignace H de Hingh; Martijn P Intven; Geert Kazemier; Johanna W Wilmink; Daan J Lips; Fennie Wit; Vincent E de Meijer; I Quintus Molenaar; Gijs A Patijn; George P van der Schelling; Martijn W J Stommel; Olivier R Busch; Bas Groot Koerkamp; Hjalmar C van Santvoort; Marc G Besselink; Dutch Pancreatic Cancer Group

doi:10.1097/SLA.0000000000005628

Outcome of Pancreatic Surgery During the First Six Years of a Mandatory Audit within the Dutch Pancreatic Cancer Group

J Annelie Suurmeijer^*, Anne Claire Henry, Bert A Bonsing, Koop Bosscha, Ronald M van Dam, Casper H van Eijck, Michael F Gerhards, Erwin van der Harst, Ignace H de Hingh, Martijn P Intven, Geert Kazemier, Johanna W Wilmink, Daan J Lips, Fennie Wit, Vincent E de Meijer, I Quintus Molenaar, Gijs A Patijn, George P van der Schelling, Martijn W J Stommel, Olivier R BuschBas Groot Koerkamp, Hjalmar C van Santvoort, Marc G Besselink, Dutch Pancreatic Cancer Group

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

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.

Original language	English
Journal	Annals of Surgery
DOIs	https://doi.org/10.1097/SLA.0000000000005628
Publication status	E-pub ahead of print - 22 Jul 2022

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10.1097/SLA.0000000000005628

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Suurmeijer, J. A., Henry, A. C., Bonsing, B. A., Bosscha, K., van Dam, R. M., van Eijck, C. H., Gerhards, M. F., van der Harst, E., de Hingh, I. H., Intven, M. P., Kazemier, G., Wilmink, J. W., Lips, D. J., Wit, F., de Meijer, V. E., Molenaar, I. Q., Patijn, G. A., van der Schelling, G. P., Stommel, M. W. J., ... Dutch Pancreatic Cancer Group (2022). Outcome of Pancreatic Surgery During the First Six Years of a Mandatory Audit within the Dutch Pancreatic Cancer Group. Annals of Surgery. https://doi.org/10.1097/SLA.0000000000005628

@article{95cae65d7c4f403d932444731ad77852,

title = "Outcome of Pancreatic Surgery During the First Six Years of a Mandatory Audit within the Dutch Pancreatic Cancer Group",

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.",

author = "Suurmeijer, {J Annelie} and Henry, {Anne Claire} and Bonsing, {Bert A} and Koop Bosscha and {van Dam}, {Ronald M} and {van Eijck}, {Casper H} and Gerhards, {Michael F} and {van der Harst}, Erwin and {de Hingh}, {Ignace H} and Intven, {Martijn P} and Geert Kazemier and Wilmink, {Johanna W} and Lips, {Daan J} and Fennie Wit and {de Meijer}, {Vincent E} and Molenaar, {I Quintus} and Patijn, {Gijs A} and {van der Schelling}, {George P} and Stommel, {Martijn W J} and Busch, {Olivier R} and Koerkamp, {Bas Groot} and {van Santvoort}, {Hjalmar C} and Besselink, {Marc G} and {Dutch Pancreatic Cancer Group}",

year = "2022",

month = jul,

day = "22",

doi = "10.1097/SLA.0000000000005628",

language = "English",

journal = "Annals of Surgery",

issn = "0003-4932",

publisher = "LIPPINCOTT WILLIAMS & WILKINS",

}

Suurmeijer, JA, Henry, AC, Bonsing, BA, Bosscha, K, van Dam, RM, van Eijck, CH, Gerhards, MF, van der Harst, E, de Hingh, IH, Intven, MP, Kazemier, G, Wilmink, JW, Lips, DJ, Wit, F, de Meijer, VE, Molenaar, IQ, Patijn, GA, van der Schelling, GP, Stommel, MWJ, Busch, OR, Koerkamp, BG, van Santvoort, HC, Besselink, MG & Dutch Pancreatic Cancer Group 2022, 'Outcome of Pancreatic Surgery During the First Six Years of a Mandatory Audit within the Dutch Pancreatic Cancer Group', Annals of Surgery. https://doi.org/10.1097/SLA.0000000000005628

TY - JOUR

T1 - Outcome of Pancreatic Surgery During the First Six Years of a Mandatory Audit within the Dutch Pancreatic Cancer Group

AU - Suurmeijer, J Annelie

AU - Henry, Anne Claire

AU - Bonsing, Bert A

AU - Bosscha, Koop

AU - van Dam, Ronald M

AU - van Eijck, Casper H

AU - Gerhards, Michael F

AU - van der Harst, Erwin

AU - de Hingh, Ignace H

AU - Intven, Martijn P

AU - Kazemier, Geert

AU - Wilmink, Johanna W

AU - Lips, Daan J

AU - Wit, Fennie

AU - de Meijer, Vincent E

AU - Molenaar, I Quintus

AU - Patijn, Gijs A

AU - van der Schelling, George P

AU - Stommel, Martijn W J

AU - Busch, Olivier R

AU - Koerkamp, Bas Groot

AU - van Santvoort, Hjalmar C

AU - Besselink, Marc G

AU - Dutch Pancreatic Cancer Group

PY - 2022/7/22

Y1 - 2022/7/22

N2 - 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.

AB - 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.

U2 - 10.1097/SLA.0000000000005628

DO - 10.1097/SLA.0000000000005628

M3 - Article

C2 - 35866656

SN - 0003-4932

JO - Annals of Surgery

JF - Annals of Surgery

ER -