Early Experience with a Hepatobiliary and Pancreatic Quality Improvement Program

Area of Science:

• Surgical Quality Improvement
• Hepatobiliary and Pancreatic (HPB) Surgery
• Postoperative Complications

Background:

• Postoperative complications significantly impact outcomes in liver, biliary, and pancreatic (HPB) surgery.
• Standardized assessment and quality improvement initiatives are crucial for enhancing patient safety in complex HPB procedures.

Purpose of the Study:

• To evaluate the effect of implementing a hepatobiliary and pancreatic (HPB) Quality Improvement Program (QIP) on postoperative complications.
• To identify and grade complications, determine their avoidability, and implement targeted action plans to reduce their occurrence.

Main Methods:

• Prospective analysis of 326 HPB surgeries over six months.
• Complications were graded using ISGPS and ISGLS criteria, with justification sought for each.
• Weekly multidisciplinary meetings reviewed complications to develop preventative action plans.

Main Results:

• Overall complication rate was 11.3% (37/326 patients), with 47 total complications, including two deaths.
• A statistically significant reduction in pancreas-related complications was observed (OR=0.30, p=0.01) post-QIP implementation.
• Liver resection complication rates showed a trend towards reduction, though not statistically significant (OR=0.63, p=0.17).

Conclusions:

• The HPB QIP provides a rigorous framework for assessing and improving surgical quality.
• The program has demonstrated a significant positive impact on reducing pancreas-related complications.
• Continued monitoring and further investigation are necessary to confirm the long-term persistence and magnitude of quality improvement.