Postoperative pancreatic fistula rates decrease over the career of pancreatic surgeons: a longitudinal cohort study
James M Halle-Smith1, Syed S Raza1, David C Bartlett1
1Hepatobiliary and Pancreatic Surgery Unit, Queen Elizabeth Hospital Birmingham, Edgbaston, Birmingham, West Midlands, B15 2TT, UK.
Background:
Patient factors are strongly linked to postoperative pancreatic fistula (POPF) but the role of surgeon experience is poorly defined in studies seeking to determine variation in POPF. The aim of this study is to report how surgeon experience influences risk-adjusted POPF rates over their careers.
Methods:
Patients undergoing pancreatoduodenectomy (PD) were identified from a prospectively maintained database. Trends in risk-adjusted POPF rates were investigated for each surgeon across their career using cumulative sum (CUSUM) analysis using an externally-validated POPF risk score.
Results:
Seven surgeons and a total of 795 PDs were included. CUSUM analysis for each surgeon demonstrated a reduction in risk-adjusted POPF rates across their career. Combined risk-adjusted POPF rates were investigated for all surgeons during the early (0-50 PDs), middle (51-100 PDs) and late (101-150 PDs) portions of their careers. This demonstrated a reduction in risk-adjusted POPF rates as surgeons progress through their careers, from early (expected 24% vs. observed 24%) to middle (expected 26% vs. observed 18%; relative reduction 25%) and late (expected 30% vs. observed 20%; relative reduction 33%).
Conclusion:
Risk-adjusted POPF rates reduce as pancreatic surgeons gain more experience. Understanding the mechanisms by which acquired experience reduces POPF rates could accelerate surgeon development.
