Textbook outcome in distal pancreatectomy: A multicenter study.

Autor: Villodre C; Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain., Del Río-Martín J; Department of Surgery, Hospital Auxilio Mutuo, San Juan, Puerto Rico., Blanco-Fernández G; Department of Surgery, Complejo Hospitalario de Badajoz, Spain., Cantalejo-Díaz M; Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain., Pardo F; Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain., Carbonell S; Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain., Muñoz-Forner E; Department of Surgery, Hospital Clínico Univertario, University of Valencia, Biomedical Research Institute, Valencia, Spain., Carabias A; Hospital Universitario de Getafe, Getafe, Spain., Manuel-Vazquez A; Hospital Universitario de Getafe, Getafe, Spain., Hernández-Rivera PJ; University of Puerto Rico School of Medicine, Department of Surgery., Jaén-Torrejimeno I; Department of Surgery, Complejo Hospitalario de Badajoz, Spain., Kälviäinen-Mejia HK; Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain., Rotellar F; Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain., Garcés-Albir M; Department of Surgery, Hospital Clínico Univertario, University of Valencia, Biomedical Research Institute, Valencia, Spain., Latorre R; Hospital Universitario de Guadalajara, Guadalajara, Spain., Longoria-Dubocq T; University of Puerto Rico School of Medicine, Department of Surgery., De Armas-Conde N; Department of Surgery, Complejo Hospitalario de Badajoz, Spain., Serrablo A; Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain., Esteban Gordillo S; Department of Surgery, Clínica Universidad de Navarra, Pamplona, Spain., Sabater L; Department of Surgery, Hospital Clínico Univertario, University of Valencia, Biomedical Research Institute, Valencia, Spain., Serradilla-Martín M; Instituto de Investigación Sanitaria Aragón, Department of Surgery, Hospital Universitario Miguel Servet, Zaragoza, Spain. Electronic address: marioserradilla@hotmail.com., Ramia JM; Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain.
Jazyk: angličtina
Zdroj: Surgery [Surgery] 2024 Apr; Vol. 175 (4), pp. 1134-1139. Date of Electronic Publication: 2023 Dec 09.
DOI: 10.1016/j.surg.2023.11.012
Abstrakt: Background: Textbook outcome is an interesting quality metrics tool. Information on textbook outcomes in distal pancreatectomy is very scarce. In this study we determined textbook outcome in a distal pancreatectomy multicenter database and propose a specific definition of textbook outcome-distal pancreatectomy that includes pancreatic fistula.
Methods: Retrospective multicenter observational study of distal pancreatectomy performed at 8 hepatopancreatobiliary surgery units from January 1, 2008, to December 31, 2018. The inclusion criteria were any scheduled distal pancreatectomy performed for any diagnosis and age > 18 years. Specific textbook outcome-distal pancreatectomy was defined as hospital stay P < 75, no Clavien-Dindo complications (≥ III), no hospital mortality, and no readmission recorded at 90 days, and the absence of pancreatic fistula (B/C).
Results: Of the 450 patients included, 262 (58.2%) obtained textbook outcomes. Prolonged stay was the parameter most frequently associated with failure to achieve textbook outcomes. The textbook outcome group presented the following results. Preoperative: lower American Society of Anesthesiologists score < III, a lower percentage of smokers, and less frequent tumor invasion of neighboring organs or vascular invasion; operative: major laparoscopic approach, and less resection of neighboring organs and less operative transfusion; postoperative: lower percentage of delayed gastric emptying and pancreatic fistula B/C, and diagnosis other an adenocarcinoma. In the multivariate study, the American Society of Anesthesiologists score > II, resection of neighboring organs, B/C pancreatic fistula, and delayed gastric emptying were associated with failure to achieve textbook outcomes.
Conclusion: The textbook outcome rate in our 450 pancreaticoduodenectomies was 58.2%. In the multivariate analysis, the causes of failure to achieve textbook outcomes were American Society of Anesthesiologists score > II, resection of neighboring organs, pancreatic fistula B/C, and delayed gastric emptying. We believe that pancreatic fistula should be added to the specific definition of textbook outcome-distal pancreatectomy because it is the most frequent complication of this procedure.
(Copyright © 2023 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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