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Failure to Rescue A...
Failure to Rescue After Pancreatoduodenectomy : A Transatlantic Analysis
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- Gleeson, Elizabeth M. (author)
- Icahn School of Medicine at Mount Sinai
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- Pitt, Henry A. (author)
- Rutgers Cancer Institute of New Jersey
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- Mackay, Tara M. (author)
- Academic Medical Center of University of Amsterdam (AMC)
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- Wellner, Ulrich F. (author)
- University Medical Center Schleswig-Holstein
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- Williamsson, Caroline (author)
- Lund University,Lunds universitet,Lever-, pankreas- och gallvägskirurgi,Forskargrupper vid Lunds universitet,LUCC: Lunds universitets cancercentrum,Övriga starka forskningsmiljöer,Hepato-Pancreato-Biliary Surgery,Lund University Research Groups,LUCC: Lund University Cancer Centre,Other Strong Research Environments,Skåne University Hospital
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- Busch, Olivier R. (author)
- Academic Medical Center of University of Amsterdam (AMC)
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- Koerkamp, Bas Groot (author)
- Erasmus University Medical Center
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- Keck, Tobias (author)
- University Medical Center Schleswig-Holstein
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- van Santvoort, Hjalmar C. (author)
- University Medical Center Utrecht
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- Tingstedt, Bobby (author)
- Lund University,Lunds universitet,Lever-, pankreas- och gallvägskirurgi,Forskargrupper vid Lunds universitet,LUCC: Lunds universitets cancercentrum,Övriga starka forskningsmiljöer,Hepato-Pancreato-Biliary Surgery,Lund University Research Groups,LUCC: Lund University Cancer Centre,Other Strong Research Environments,Skåne University Hospital
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- Besselink, Marc G. (author)
- Academic Medical Center of University of Amsterdam (AMC)
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(creator_code:org_t)
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- 2021
- 2021
- English 8 s.
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In: Annals of Surgery. - 1528-1140. ; 274:3, s. 459-466
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http://dx.doi.org/10...
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Abstract
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- OBJECTIVE: This analysis aimed to compare failure to rescue (FTR) after pancreatoduodenectomy across the Atlantic. SUMMARY BACKGROUND DATA: FTR, or mortality after development of a major complication, is a quality metric originally created to compare hospital results. FTR has been studied in North American and Northern European patients undergoing pancreatoduodenectomy (PD). However, a direct comparison of FTR after PD between North America and Northern Europe has not been performed. METHODS: Patients who underwent PD in North America, the Netherlands, Sweden and Germany (GAPASURG dataset) were identified from their respective registries (2014-17). Patients who developed a major complication defined as Clavien-Dindo ≥3 or developed a grade B/C postoperative pancreatic fistula (POPF) were included. Preoperative, intraoperative, and postoperative variables were compared between patients with and without FTR. Variables significant on univariable analysis were entered into a logistic regression for FTR. RESULTS: Major complications occurred in 6188 of 22,983 patients (26.9%) after PD, and 504 (8.1%) patients had FTR. North American and Northern European patients with complications differed, and rates of FTR were lower in North America (5.4% vs 12%, P < 0.001). Fourteen factors from univariable analysis contributing to differences in patients who developed FTR were included in a logistic regression. On multivariable analysis, factors independently associated with FTR were age, American Society of Anesthesiology ≥3, Northern Europe, POPF, organ failure, life-threatening complication, nonradiologic intervention, and reoperation. CONCLUSIONS: Older patients with severe systemic diseases are more difficult to rescue. Failure to rescue is more common in Northern Europe than North America. In stable patients, management of complications by interventional radiology is preferred over reoperation.
Subject headings
- MEDICIN OCH HÄLSOVETENSKAP -- Klinisk medicin -- Kirurgi (hsv//swe)
- MEDICAL AND HEALTH SCIENCES -- Clinical Medicine -- Surgery (hsv//eng)
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Gleeson, Elizabe ...
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Pitt, Henry A.
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Mackay, Tara M.
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Wellner, Ulrich ...
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Williamsson, Car ...
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Busch, Olivier R ...
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Koerkamp, Bas Gr ...
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Keck, Tobias
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van Santvoort, H ...
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Tingstedt, Bobby
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Besselink, Marc ...
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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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Annals of Surger ...
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Lund University