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Bloomfield GC, Radkani P, Nigam A, Namgoong J, Chou J, Park BU, Fishbein TM, Winslow ER. Approach to postpancreatectomy care Impacts outcomes: Retrospective Validation of the PORSCH trial. Am J Surg 2024:S0002-9610(24)00273-3. [PMID: 38782685 DOI: 10.1016/j.amjsurg.2024.05.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/21/2024] [Accepted: 05/15/2024] [Indexed: 05/25/2024]
Abstract
BACKGROUND In the recent PORSCH trial, a three-part postpancreatectomy care algorithm was employed with a near 50 % reduction in mortality. We hypothesized that clinical care congruent with this protocol would correlate with better outcomes in our patients. METHODS Real-world postoperative care was compared to the pathway described by the PORSCH trial and patients were assigned into groups based on congruence with its recommendations. The primary composite outcome (PCO) consisted of 90-day mortality, organ failure, and interventions for bleeding. RESULTS Of 289 patients, care of 12 % was entirely congruent with the PORSCH algorithm. The PCO was recorded in 9 % of the PORSCH care group, 8 % of the Partial-PORSCH care group, and 19 % of the Non-PORSCH care group (p = 0.044). Adverse outcomes were highest when pancreaticoduodenectomy patients received care incongruent with the algorithm's CT imaging recommendations. CONCLUSIONS These results add external validity to the principles of clinical care underlying the PORSCH algorithm.
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Affiliation(s)
| | - Pejman Radkani
- Department of Transplant Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Aradhya Nigam
- Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Jean Namgoong
- Georgetown University School of Medicine, Washington, DC, USA
| | - Jiling Chou
- MedStar Health Research Institute Department of Biostatistics & Biomedical Informatics, Hyattsville, MD, USA
| | - Byoung Uk Park
- Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
| | - Thomas M Fishbein
- Department of Transplant Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
| | - Emily R Winslow
- University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.
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Huerta CT, Collier AL, Hernandez AE, Rodriguez C, Shah A, Kronenfeld JP, Franceschi DF, Sleeman D, Livingstone AS, Thorson CM. Nationwide Outcomes of Pancreaticoduodenectomy for Pancreatic Malignancies: Center Volume Matters. Am Surg 2023; 89:6020-6029. [PMID: 37310685 PMCID: PMC10883718 DOI: 10.1177/00031348231184198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Complex surgeries such as pancreaticoduodenectomies (PD) have been shown to have better outcomes when performed at high-volume centers (HVCs) compared to low-volume centers (LVCs). Few studies have compared these factors on a national level. The purpose of this study was to analyze nationwide outcomes for patients undergoing PD across hospital centers with different surgical volumes. METHODS The Nationwide Readmissions Database (2010-2014) was queried for all patients who underwent open PD for pancreatic carcinoma. High-volume centers were defined as hospitals where 20 or more PDs were performed per year. Sociodemographic factors, readmission rates, and perioperative outcomes were compared before and after propensity score-matched analysis (PSMA) for 76 covariates including demographics, hospital factors, comorbidities, and additional diagnoses. Results were weighted for national estimates. RESULTS A total of 19,810 patients were identified with age 66 ± 11 years. There were 6,840 (35%) cases performed at LVCs, and 12,970 (65%) at HVCs. Patient comorbidities were greater in the LVC cohort, and more PDs were performed at teaching hospitals in the HVC cohort. These discrepancies were controlled for with PSMA. Length of stay (LOS), mortality, invasive procedures, and perioperative complications were greater in LVCs when compared to HVCs before and after PSMA. Additionally, readmission rates at one year (38% vs 34%, P < .001) and readmission complications were greater in the LVC cohort. CONCLUSIONS Pancreaticoduodenectomy is more commonly performed at HVCs, which is associated with less complications and improved outcomes compared to LVCs.
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Affiliation(s)
| | - Amber L Collier
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL, USA
| | | | - Cindy Rodriguez
- Florida State University College of Medicine, Tallahassee, FL, USA
| | - Ankit Shah
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua P Kronenfeld
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL, USA
| | - Dido F Franceschi
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL, USA
- Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Danny Sleeman
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL, USA
- Division of General Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alan S Livingstone
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL, USA
- Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL, USA
- Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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3
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Kovoor JG, Bacchi S, Gupta AK, O'Callaghan PG, Trochsler MI, Maddern GJ. Standardizing optimization in surgery. ANZ J Surg 2023; 93:24-25. [PMID: 36546639 DOI: 10.1111/ans.18201] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Joshua G Kovoor
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia.,Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Health and Information, Adelaide, South Australia, Australia
| | - Stephen Bacchi
- Health and Information, Adelaide, South Australia, Australia.,Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Flinders Medical Centre, Flinders University, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia
| | - Aashray K Gupta
- Health and Information, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia.,Gold Coast University Hospital, Gold Coast, Queensland, Australia
| | - Patrick G O'Callaghan
- Royal Adelaide Hospital, Adelaide, South Australia, Australia.,University of Adelaide, Adelaide, South Australia, Australia
| | - Markus I Trochsler
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia
| | - Guy J Maddern
- Discipline of Surgery, The Queen Elizabeth Hospital, University of Adelaide, Adelaide, South Australia, Australia.,Royal Australasian College of Surgeons, Adelaide, South Australia, Australia.,Health and Information, Adelaide, South Australia, Australia
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Houghton EJ, Rubio JS. Surgical management of the postoperative complications of hepato-pancreato-biliary surgery. INTERNATIONAL JOURNAL OF GASTROINTESTINAL INTERVENTION 2022. [DOI: 10.18528/ijgii220041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Affiliation(s)
- Eduardo Javier Houghton
- Teaching and Research Department, DAICIM Foundation, Buenos Aires, Argentina
- Surgery Division, B. Rivadavia Hospital, Buenos Aires, Argentina
- Department of Surgery, School of Medicine, University of Buenos Aires, Buenos Aires, Argentina
| | - Juan Santiago Rubio
- Solid Organ Transplant Service, Hospital de Alta Complejidad en Red El Cruce Dr. Néstor Carlos Kirchner, Buenos Aires, Argentina
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Trends in pancreatic surgery in Switzerland: a survey and nationwide analysis over two decades. Langenbecks Arch Surg 2022; 407:3423-3435. [DOI: 10.1007/s00423-022-02679-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 09/08/2022] [Indexed: 12/24/2022]
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