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Can trainees safely...
Can trainees safely perform pancreatoenteric anastomosis? A systematic review, meta-analysis, and risk-adjusted analysis of postoperative pancreatic fistula
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- Pande, Rupaly (author)
- New Queen Elizabeth Hospital
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- Halle-Smith, James M. (author)
- New Queen Elizabeth Hospital
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- Thorne, Thomas (author)
- New Queen Elizabeth Hospital
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- Hiddema, Lydia (author)
- New Queen Elizabeth Hospital
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- Hodson, James (author)
- New Queen Elizabeth Hospital
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- Roberts, Keith J. (author)
- New Queen Elizabeth Hospital,University of Birmingham
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Arshad, Ali (author)
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- Connor, Saxon (author)
- Christchurch Hospital New Zealand
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- Conlon, Kevin C.P. (author)
- Trinity College Dublin
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- Dickson, Euan J. (author)
- Glasgow Royal Infirmary
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- Giovinazzo, Francesco (author)
- Policlinico Universitario Agostino Gemelli
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- Harrison, Ewen (author)
- University of Edinburgh
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- de Liguori Carino, Nicola (author)
- Manchester University NHS Foundation Trust
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- Hore, Todd (author)
- Christchurch Hospital New Zealand
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- Knight, Stephen R. (author)
- University of Edinburgh
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- Loveday, Benjamin (author)
- Royal Melbourne Hospital
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- Magill, Laura (author)
- University of Birmingham
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- Mirza, Darius (author)
- New Queen Elizabeth Hospital
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- Pandanaboyana, Sanjay (author)
- Freeman Hospital
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- Perry, Rita J. (author)
- University of Birmingham
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- Pinkney, Thomas (author)
- University of Birmingham
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- Siriwardena, Ajith K. (author)
- Manchester University NHS Foundation Trust
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- Satoi, Sohei (author)
- Kansai Medical University,University of Colorado
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Skipworth, James (author)
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Stättner, Stefan (author)
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- Sutcliffe, Robert P. (author)
- New Queen Elizabeth Hospital
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- Tingstedt, Bobby (author)
- Lund University,Lunds universitet,Kirurgi, Lund,Sektion V,Institutionen för kliniska vetenskaper, Lund,Medicinska fakulteten,Lever-, pankreas- och gallvägskirurgi,Forskargrupper vid Lunds universitet,LUCC: Lunds universitets cancercentrum,Övriga starka forskningsmiljöer,Surgery (Lund),Section V,Department of Clinical Sciences, Lund,Faculty of Medicine,Hepato-Pancreato-Biliary Surgery,Lund University Research Groups,LUCC: Lund University Cancer Centre,Other Strong Research Environments
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(creator_code:org_t)
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- Elsevier BV, 2022
- 2022
- English.
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In: Surgery (United States). - : Elsevier BV. - 0039-6060. ; 172:1, s. 319-328
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http://dx.doi.org/10...
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Abstract
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- Background: The complexity of pancreaticoduodenectomy and fear of morbidity, particularly postoperative pancreatic fistula, can be a barrier to surgical trainees gaining operative experience. This meta-analysis sought to compare the postoperative pancreatic fistula rate after pancreatoenteric anastomosis by trainees or established surgeons. Methods: A systematic review of the literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with differences in postoperative pancreatic fistula rates after pancreatoenteric anastomosis between trainee-led versus consultant/attending surgeons pooled using meta-analysis. Variation in rates of postoperative pancreatic fistula was further explored using risk-adjusted outcomes using published risk scores and cumulative sum control chart analysis in a retrospective cohort. Results: Across 14 cohorts included in the meta-analysis, trainees tended toward a lower but nonsignificant rate of all postoperative pancreatic fistula (odds ratio: 0.77, P =.45) and clinically relevant postoperative pancreatic fistula (odds ratio: 0.69, P =.37). However, there was evidence of case selection, with trainees being less likely to operate on patients with a pancreatic duct width <3 mm (odds ratio: 0.45, P =.05). Similarly, analysis of a retrospective cohort (N = 756 cases) found patients operated by trainees to have significantly lower predicted all postoperative pancreatic fistula (median: 20 vs 26%, P <.001) and clinically relevant postoperative pancreatic fistula (7 vs 9%, P =.020) rates than consultant/attending surgeons, based on preoperative risk scores. After adjusting for this on multivariable analysis, the risks of all postoperative pancreatic fistula (odds ratio: 1.18, P =.604) and clinically relevant postoperative pancreatic fistula (odds ratio: 0.85, P =.693) remained similar after pancreatoenteric anastomosis by trainees or consultant/attending surgeons. Conclusion: Pancreatoenteric anastomosis, when performed by trainees, is associated with acceptable outcomes. There is evidence of case selection among patients undergoing surgery by trainees; hence, risk adjustment provides a critical tool for the objective evaluation of performance.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
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- By the author/editor
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Pande, Rupaly
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Halle-Smith, Jam ...
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Thorne, Thomas
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Hiddema, Lydia
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Hodson, James
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Roberts, Keith J ...
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show more...
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Arshad, Ali
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Connor, Saxon
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Conlon, Kevin C. ...
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Dickson, Euan J.
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Giovinazzo, Fran ...
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Harrison, Ewen
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de Liguori Carin ...
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Hore, Todd
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Knight, Stephen ...
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Loveday, Benjami ...
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Magill, Laura
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Mirza, Darius
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Pandanaboyana, S ...
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Perry, Rita J.
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Pinkney, Thomas
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Siriwardena, Aji ...
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Satoi, Sohei
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Skipworth, James
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Stättner, Stefan
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Sutcliffe, Rober ...
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Tingstedt, Bobby
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- About the subject
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- MEDICAL AND HEALTH SCIENCES
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MEDICAL AND HEAL ...
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and Clinical Medicin ...
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and Surgery
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Surgery (United ...
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Lund University