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 journalArticleAcademicpeer-review

Abstract

Objective: To describe outcome after pancreatic surgery in the first 6 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 (PD) and distal pancreatectomy from the mandatory Dutch Pancreatic Cancer Audit (January 2014-December 2019). Patient, tumor, and treatment characteristics were compared between 3 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 (FTR) and in-hospital mortality. Results: Overall, 5345 patients were included, of whom 4227 after PD and 1118 after distal pancreatectomy. After PD, FTR improved from 13% to 7.4% [odds ratio (OR) 0.64, 95% confidence interval (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%-22%, P=0.006), American Society of Anesthesiologists score ≥3 (19%-31%, P<0.001) and Charlson comorbidity score ≥2 (24%-34%, P<0.001). The rates of textbook outcome (57%-55%, P=0.283) and major complications remained stable (31%-33%, P=0.207), whereas complication-related intensive care admission decreased (13%-9%, P=0.002). After distal pancreatectomy, improvements in FTR 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 6 years of a nationwide audit, in-hospital mortality and FTR after PD improved despite operating on more high-risk patients. Several collaborative efforts may have contributed to these improvements.

Original languageEnglish
Pages (from-to)260-266
Number of pages7
JournalAnnals of Surgery
Volume278
Issue number2
Early online date22 Jul 2022
DOIs
Publication statusPublished - 1 Aug 2023

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