4.6 Article

Surgeon experience contributes to improved outcomes in pancreatoduodenectomies at high risk for fistula development

期刊

SURGERY
卷 169, 期 4, 页码 708-720

出版社

MOSBY-ELSEVIER
DOI: 10.1016/j.surg.2020.11.022

关键词

-

类别

向作者/读者索取更多资源

The experience of surgeons plays a crucial role in achieving better outcomes after high-risk pancreatoduodenectomy. Increasing career volume and years of practice are associated with a decreased rate of clinically relevant pancreatic fistula. Specific operative approaches, such as pancreatojejunostomy reconstruction and omitting prophylactic octreotide, along with minimizing blood loss, are effective strategies for preventing clinically relevant pancreatic fistula.
Background: Pancreatoduodenectomies at high risk for clinically relevant pancreatic fistula are uncommon, yet intimidating, situations. In such scenarios, the impact of individual surgeon experience on outcomes is poorly understood. Methods: The fistula risk score was applied to identify high-risk patients (fistula risk score 7-10) from 7,706 pancreatoduodenectomies performed at 18 international institutions (2003-2020). For each case, surgeon pancreatoduodenectomy career volume and years of practice were linked to intraoperative fistula mitigation strategy adoption and outcomes. Consequently, best operative approaches for clinically relevant pancreatic fistula prevention and best performer profiles were identified through multivariable analysis models. Results: Eight hundred and thirty high-risk pancreatoduodenectomies, performed by 64 surgeons, displayed an overall clinically relevant pancreatic fistula rate of 33.7%. Clinically relevant pancreatic fistula rates decreased with escalating surgeon career pancreatoduodenectomy (-49.7%) and career length (-41.2%; both P < .001), as did transfusion and reoperation rates, postoperative morbidity index, and duration of stay. Great experience (>400 pancreatoduodenectomies performed or >21-year-long career) was a significant predictor of clinically relevant pancreatic fistula prevention (odds ratio 0.52, 95% confidence interval 0.35-0.76) and was more often associated with pancreatojejunostomy reconstruc-tion and prophylactic octreotide omission, which were both independently associated with clinically relevant pancreatic fistula reduction. A risk-adjusted performance analysis also correlated with experi-ence. Moreover, minimizing blood loss (<400 mL) significantly contributed to clinically relevant pancreatic fistula prevention (odds ratio 0.40, 95% confidence interval 0.22-0.74). Conclusion: Surgeon experience is a key contributor to achieve better outcomes after high-risk pan-creatoduodenectomy. Surgeons can improve their performance in these challenging situations by employing pancreatojejunostomy reconstruction, omitting prophylactic octreotide, and minimizing blood loss. (c) 2020 Elsevier Inc. All rights reserved.

作者

我是这篇论文的作者
点击您的名字以认领此论文并将其添加到您的个人资料中。

评论

主要评分

4.6
评分不足

次要评分

新颖性
-
重要性
-
科学严谨性
-
评价这篇论文

推荐

暂无数据
暂无数据