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Textbook outcome in distal pancreatectomy: A multicenter study
Celia Villodre1, Juan Del Río-Martín2, Gerardo Blanco-Fernández3
1Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain; ISABIAL: Instituto de Investigación Sanitaria y Biomédica de Alicante, Alicante, Spain; Universidad Miguel Hernández, Alicante, Spain.
Surgery
|December 9, 2023
Summary
This study evaluated textbook outcomes in distal pancreatectomy, finding 58.2% achieved this standard. Pancreatic fistula and other complications significantly impact achieving optimal outcomes in this procedure.
Area of Science:
- Hepatobiliary Surgery
- Surgical Quality Metrics
- Gastrointestinal Oncology
Background:
- Textbook outcome is a valuable quality metric in surgery, but data for distal pancreatectomy is limited.
- This study addresses the scarcity of information on textbook outcomes specifically for distal pancreatectomy.
- A novel definition for textbook outcome in distal pancreatectomy is proposed, incorporating pancreatic fistula as a key indicator.
Purpose of the Study:
- To determine the rate of textbook outcomes in a multicenter distal pancreatectomy database.
- To identify factors associated with achieving or failing to achieve textbook outcomes in distal pancreatectomy.
- To propose a refined definition of textbook outcome for distal pancreatectomy that includes pancreatic fistula.
Main Methods:
- A retrospective multicenter observational study included 450 distal pancreatectomy cases from 2008-2018.
- Textbook outcome was defined by specific criteria: hospital stay < 75 days, no severe complications (Clavien-Dindo ≥ III), no hospital mortality, no 90-day readmission, and absence of pancreatic fistula (B/C).
- Multivariate analysis was used to identify predictors of failure to achieve textbook outcomes.
Main Results:
- 58.2% of patients (262/450) achieved textbook outcomes.
- Prolonged hospital stay was the most common reason for not achieving textbook outcomes.
- Factors associated with failure included higher American Society of Anesthesiologists score (>II), resection of neighboring organs, pancreatic fistula (B/C), and delayed gastric emptying.
Conclusions:
- The study established a textbook outcome rate of 58.2% for distal pancreatectomy.
- Higher American Society of Anesthesiologists score, organ resection, pancreatic fistula, and delayed gastric emptying were identified as key factors preventing textbook outcomes.
- Pancreatic fistula should be included in the definition of textbook outcome for distal pancreatectomy due to its high frequency and impact.
