Optimal Pancreatic Surgery: Are We Making Progress in North America?

Area of Science:

• Surgical Quality Improvement
• Pancreatic Surgery Outcomes
• Health Services Research

Background:

• Pancreatectomy procedures like pancreatoduodenectomy (PD) and distal pancreatectomy (DP) have high morbidity rates.
• Composite measures are increasingly recognized for accurately defining surgical quality in complex procedures.
• Assessing trends in surgical management and outcomes is crucial for improving patient care.

Purpose of the Study:

• To evaluate North American trends in the management of patients undergoing pancreatoduodenectomy (PD) and distal pancreatectomy (DP).
• To quantify the delivery of optimal pancreatic surgery based on a composite measure of quality.
• To identify changes in surgical processes and postoperative outcomes over a defined period.

Main Methods:

• Utilized the 2013-2017 American College of Surgeons National Surgical Quality Improvement Program Participant Use Files.
• Analyzed patient, process, procedure, and 30-day postoperative outcome variables for PD (N=16,222) and DP (N=7946) cohorts.
• Defined optimal pancreatic surgery as absence of mortality, serious morbidity, reoperation, readmission, and achieving length of stay ≤75th percentile.

Main Results:

• Minimally invasive PD use remained stable, while robotic PD increased and laparoscopic PD decreased.
• Operative times and transfusion rates decreased; drain management improved (amylase checks, earlier removal).
• Overall morbidity, mortality, and length of stay decreased, with optimal pancreatic surgery rates increasing by 3-5% for PD and DP.

Conclusions:

• Pancreatectomy care in North America evolved between 2013-2017, with improvements in pre-, intra-, and perioperative processes.
• Postoperative outcomes, including morbidity, mortality, and length of stay, showed significant improvement.
• The rate of optimal pancreatic surgery increased, highlighting progress in surgical quality for these complex procedures.