1. Variation in hospital mortality after pancreatoduodenectomy is related to failure to rescue rather than major complications: a nationwide audit.
- Author
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van Rijssen LB, Zwart MJ, van Dieren S, de Rooij T, Bonsing BA, Bosscha K, van Dam RM, van Eijck CH, Gerhards MF, Gerritsen JJ, van der Harst E, de Hingh IH, de Jong KP, Kazemier G, Klaase J, van der Kolk BM, van Laarhoven CJ, Luyer MD, Molenaar IQ, Patijn GA, Rupert CG, Scheepers JJ, van der Schelling GP, Vahrmeijer AL, Busch ORC, van Santvoort HC, Groot Koerkamp B, and Besselink MG
- Subjects
- Aged, Digestive System Neoplasms mortality, Digestive System Neoplasms pathology, Female, Humans, Male, Medical Audit trends, Middle Aged, Neoplasm Staging, Netherlands epidemiology, Pancreaticoduodenectomy adverse effects, Pancreaticoduodenectomy trends, Risk Assessment, Risk Factors, Time Factors, Digestive System Neoplasms surgery, Failure to Rescue, Health Care trends, Healthcare Disparities trends, Hospital Mortality trends, Outcome and Process Assessment, Health Care trends, Pancreaticoduodenectomy mortality, Postoperative Complications mortality, Quality Indicators, Health Care trends
- Abstract
Background: In the mandatory nationwide Dutch Pancreatic Cancer Audit, rates of major complications and Failure to Rescue (FTR) after pancreatoduodenectomy between low- and high-mortality hospitals are compared, and independent predictors for FTR investigated., Methods: Patients undergoing pancreatoduodenectomy in 2014 and 2015 in The Netherlands were included. Hospitals were divided into quartiles based on mortality rates. The rate of major complications (Clavien-Dindo ≥3) and death after a major complication (FTR) were compared between these quartiles. Independent predictors for FTR were identified by multivariable logistic regression analysis., Results: Out of 1.342 patients, 391 (29%) developed a major complication and in-hospital mortality was 4.2%. FTR occurred in 56 (14.3%) patients. Mortality was 0.9% in the first hospital quartile (4 hospitals, 327 patients) and 8.1% in the fourth quartile (5 hospitals, 310 patients). The rate of major complications increased by 40% (25.7% vs 35.2%) between the first and fourth hospital quartile, whereas the FTR rate increased by 560% (3.6% vs 22.9%). Independent predictors of FTR were male sex (OR = 2.1, 95%CI 1.2-3.9), age >75 years (OR = 4.3, 1.8-10.2), BMI ≥30 (OR = 2.9, 1.3-6.6), histopathological diagnosis of periampullary cancer (OR = 2.0, 1.1-3.7), and hospital volume <30 (OR = 3.9, 1.6-9.6)., Conclusions: Variations in mortality between hospitals after pancreatoduodenectomy were explained mainly by differences in FTR, rather than the incidence of major complications., (Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.)
- Published
- 2018
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