1. Textbook Outcome
- Author
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Roessel, S. van, Mackay, T.M., Dieren, S. van, Schelling, G.P. van der, Nieuwenhutjs, V.B., Bosscha, K., Harst, E. van der, Dam, R.M. van, Liem, M.S.L., Festen, S., Stommel, M.W.J., Roos, D., Wit, F., Molenaar, I.Q., Meijer, V.E. de, Kazemier, G., Hingh, I.H.J.T. de, Santvoort, H.C. van, Bonsing, B.A., Busch, O.R., Koerkamp, B.G., Besselink, M.G., Dutch Pancreatic Canc Grp, RS: NUTRIM - R2 - Liver and digestive health, MUMC+: MA Heelkunde (9), Graduate School, CCA - Cancer Treatment and Quality of Life, AGEM - Digestive immunity, AGEM - Endocrinology, metabolism and nutrition, AGEM - Re-generation and cancer of the digestive system, Surgery, and APH - Methodology
- Subjects
Male ,INDICATORS ,medicine.medical_treatment ,INTERNATIONAL STUDY-GROUP ,Logistic regression ,outcomes ,Gastroenterology ,surgery ,Tumours of the digestive tract Radboud Institute for Health Sciences [Radboudumc 14] ,0302 clinical medicine ,Postoperative Complications ,MARGIN STATUS ,Medicine ,IN-HOSPITAL MORTALITY ,Hospital Mortality ,Registries ,Textbooks as Topic ,pancreatic surgery ,Neoadjuvant therapy ,Netherlands ,Response rate (survey) ,major complications ,Incidence (epidemiology) ,Incidence ,Middle Aged ,medicine.anatomical_structure ,textbook outcome ,Pancreatic fistula ,030220 oncology & carcinogenesis ,030211 gastroenterology & hepatology ,Female ,medicine.medical_specialty ,germany ,CLASSIFICATION ,Pancreaticoduodenectomy ,03 medical and health sciences ,Pancreatectomy ,Pancreatic cancer ,Internal medicine ,Humans ,fistula ,care ,Aged ,Quality Indicators, Health Care ,Retrospective Studies ,Pancreatic duct ,COMPOSITE-MEASURE ,business.industry ,Retrospective cohort study ,medicine.disease ,auditing ,Pancreatic Neoplasms ,business ,practice variation - Abstract
Contains fulltext : 226022.pdf (Publisher’s version ) (Closed access) BACKGROUND: Textbook outcome (TO) is a multidimensional measure for quality assurance, reflecting the "ideal" surgical outcome. METHODS: Post-hoc analysis of patients who underwent pancreatoduodenectomy (PD) or distal pancreatectomy (DP) for all indications between 2014 and 2017, queried from the nationwide prospective Dutch Pancreatic Cancer Audit. An international survey was conducted among 24 experts from 10 countries to reach consensus on the requirements for TO in pancreatic surgery. Univariable and multivariable logistic regression was performed to identify TO predictors. Between-hospital variation in TO rates was compared using observed-versus-expected rates. RESULTS: Based on the survey (92% response rate), TO was defined by the absence of postoperative pancreatic fistula, bile leak, postpancreatectomy hemorrhage (all ISGPS grade B/C), severe complications (Clavien-Dindo ≥III), readmission, and in-hospital mortality. Overall, 3341 patients were included (2633 (79%) PD and 708 (21%) DP) of whom 60.3% achieved TO; 58.3% for PD and 67.4% for DP. On multivariable analysis, ASA class 3 predicted a worse TO rate after PD (ASA 3 OR 0.59 [0.44-0.80]), whereas a dilated pancreatic duct (>3 mm) and pancreatic ductal adenocarcinoma (PDAC) were associated with a better TO rate (OR 2.22 [2.05-3.57] and OR 1.36 [1.14-1.63], respectively). For DP, female sex and the absence of neoadjuvant therapy predicted better TO rates (OR 1.38 [1.01-1.90] and OR 2.53 [1.20-5.31], respectively). When comparing institutions, the observed-versus-expected rate for achieving TO varied from 0.71 to 1.46 per hospital after casemix-adjustment. CONCLUSIONS: TO is a novel quality measure in pancreatic surgery. TO varies considerably between pancreatic centers, demonstrating the potential benefit of quality assurance programs.
- Published
- 2020
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