Benchmarks in Pancreatic Surgery: A Novel Tool for Unbiased Outcome Comparisons

Area of Science:

• Surgical outcomes research
• Pancreatic surgery standardization
• Healthcare quality improvement

Background:

• Current outcomes after pancreaticoduodenectomy (PD) lack standardized benchmarks, hindering comparative analysis.
• The best achievable results following PD are not well-defined, making comparisons speculative.
• Variability in PD outcomes necessitates the establishment of reliable reference points.

Purpose of the Study:

• To establish robust and standardized outcome benchmarks for pancreaticoduodenectomy (PD).
• To enable meaningful comparisons of PD outcomes across different patient cohorts, centers, and surgical techniques.
• To define best achievable results after PD using a benchmarking approach.

Main Methods:

• Analysis of consecutive PD cases (2012-2015) from 23 international expert centers.
• Identification of 20 outcome benchmarks using low-risk PD cases (no comorbidities, no major vascular resection).
• Validation of benchmarks in cohorts with higher comorbidity (ASA class ≥3) and minimally invasive approaches.

Main Results:

• Low-risk PD cases (38%) showed low in-hospital mortality (≤1.6%) but high cumulative morbidity (73% within 6 months).
• Established benchmark cutoffs: pancreatic fistulas (19%), severe complications (30%), and failure-to-rescue (9%).
• Higher comorbidity cohort (ASA ≥3) had increased in-hospital mortality (3%) and failure-to-rescue (16%) compared to benchmarks.

Conclusions:

• Proposed PD outcome benchmarks, derived from a large international cohort, facilitate standardized comparisons.
• These benchmarks can be applied to assess outcomes across diverse patient groups, institutions, and surgical modalities.
• Benchmarking aids in evaluating the quality of care and identifying areas for improvement in pancreatic surgery.