Risk adjusted assessment of individual surgeon's pancreatic fistula outcomes.

Roberts, Keith J and Boteon, Amanda P C S and Marcon, Francesca and Abradelo, Manuel and Dasari, Bobby and Muiesan, Paolo and Marudanayagam, Ravi and Sutcliffe, Robert P and Isaac, John and Mirza, Darius F (2019) Risk adjusted assessment of individual surgeon's pancreatic fistula outcomes. HPB : the official journal of the International Hepato Pancreato Biliary Association. ISSN 1477-2574. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs

Full text not available from this repository.
Official URL: https://www.hpbonline.org/article/S1365-182X(19)30...

Abstract

BACKGROUND

Post-operative pancreatic fistula (POPF) is a major cause of morbidity following pancreatoduodenectomy. The risk of POPF varies between individuals and thus assessment without risk adjustment is crude. However, despite the availability of numerous scores to determine risk, no study has provided a risk adjusted assessment of POPF outcomes.

METHODS

The observed and risk adjusted occurrence of POPF from consecutive patients operated upon by eight surgeons were recorded. Surgeons varied in experience from newly appointed (n = 5) to established (n = 3). CUSUM (cumulative sum) analysis was used to assess performance.

RESULTS

104 POPF occurred among 519 patients (20.0%). The occurrence of POPF was significantly lower among experienced surgeons (20/186, 10.7% vs 84/333, 25.2%; p < 0.001). Following risk adjustment surgeons observed 16.6 fewer to 6.5 excess POPF per 100 patients than predicted. Analysis of the CUSUM plots demonstrated the experienced surgeons performed steadily with a gradual reduction in observed POPF compared to what was predicted. The new surgeon's performance was less consistent and evidence of a learning curve was observed with steady improvement occurring after 50-70 patients.

CONCLUSIONS

Risk adjusted assessment of POPF demonstrates differences between experienced and less experienced surgeons. This method could be used to audit practice and observe effects of changes to technique.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs
Subjects: WI Digestive system. Gastroenterology
Divisions: Planned IP Care > Gastroentrology
Related URLs:
Depositing User: Mrs Semanti Chakraborty
Date Deposited: 03 Sep 2019 15:46
Last Modified: 03 Sep 2019 15:46
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2359

Actions (login required)

View Item View Item