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Giani A, van Ramshorst T, Mazzola M, Bassi C, Esposito A, de Pastena M, Edwin B, Sahakyan M, Kleive D, Jah A, van Laarhoven S, Boggi U, Kauffman EF, Casadei R, Ricci C, Dokmak S, Ftériche FS, White SA, Kamarajah SK, Butturini G, Frigerio I, Zerbi A, Capretti G, Pando E, Sutcliffe RP, Marudanayagam R, Fusai GK, Fabre JM, Björnsson B, Timmermann L, Soonawalla Z, Burdio F, Keck T, Hackert T, Groot Koerkamp B, d’Hondt M, Coratti A, Pessaux P, Pietrabissa A, Al-Sarireh B, Marino MV, Molenaar Q, Yip V, Besselink M, Ferrari G, Hilal MA. Benchmarking of minimally invasive distal pancreatectomy with splenectomy: European multicentre study. Br J Surg 2022; 109:1124-1130. [DOI: 10.1093/bjs/znac204] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Revised: 04/14/2022] [Accepted: 05/17/2022] [Indexed: 11/14/2022]
Abstract
Abstract
Background
Benchmarking is the process to used assess the best achievable results and compare outcomes with that standard. This study aimed to assess best achievable outcomes in minimally invasive distal pancreatectomy with splenectomy (MIDPS).
Methods
This retrospective study included consecutive patients undergoing MIDPS for any indication, between 2003 and 2019, in 31 European centres. Benchmarks of the main clinical outcomes were calculated according to the Achievable Benchmark of Care (ABC™) method. After identifying independent risk factors for severe morbidity and conversion, risk-adjusted ABCs were calculated for each subgroup of patients at risk.
Results
A total of 1595 patients were included. The ABC was 2.5 per cent for conversion and 8.4 per cent for severe morbidity. ABC values were 160 min for duration of operation time, 8.3 per cent for POPF, 1.8 per cent for reoperation, and 0 per cent for mortality. Multivariable analysis showed that conversion was associated with male sex (OR 1.48), BMI exceeding 30 kg/m2 (OR 2.42), multivisceral resection (OR 3.04), and laparoscopy (OR 2.24). Increased risk of severe morbidity was associated with ASA fitness grade above II (OR 1.60), multivisceral resection (OR 1.88), and robotic approach (OR 1.87).
Conclusion
The benchmark values obtained using the ABC method represent optimal outcomes from best achievable care, including low complication rates and zero mortality. These benchmarks should be used to set standards to improve patient outcomes.
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Affiliation(s)
- Alessandro Giani
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza , Brescia , Italy
| | - Tess van Ramshorst
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza , Brescia , Italy
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Centre Amsterdam , Amsterdam , the Netherlands
| | - Michele Mazzola
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | - Claudio Bassi
- Department of Surgery, Pancreas Institute, Verona University Hospital , Verona , Italy
| | - Alessandro Esposito
- Department of Surgery, Pancreas Institute, Verona University Hospital , Verona , Italy
| | - Matteo de Pastena
- Department of Surgery, Pancreas Institute, Verona University Hospital , Verona , Italy
| | - Bjørn Edwin
- Intervention Centre and Department of Hepatopancreatobiliary Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo , Oslo Norway
| | - Mushegh Sahakyan
- Intervention Centre and Department of Hepatopancreatobiliary Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo , Oslo Norway
| | - Dyre Kleive
- Intervention Centre and Department of Hepatopancreatobiliary Surgery, Oslo University Hospital and Institute of Medicine, University of Oslo , Oslo Norway
| | - Asif Jah
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - Stijn van Laarhoven
- Department of Surgery, Cambridge University Hospitals NHS Foundation Trust , Cambridge , UK
| | - Ugo Boggi
- Department of Surgery, University Hospital of Pisa , Pisa , Italy
| | | | - Riccardo Casadei
- Department of Surgery, Sant’Orsola Malpighi Hospital , Bologna , Italy
| | - Claudio Ricci
- Department of Surgery, Sant’Orsola Malpighi Hospital , Bologna , Italy
| | - Safi Dokmak
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital , Clichy , France
| | - Fadhel Samir Ftériche
- Department of Hepatopancreatobiliary Surgery and Liver Transplantation, Beaujon Hospital , Clichy , France
| | - Steven A White
- Department of Surgery, Freeman Hospital Newcastle upon Tyne , Newcastle upon Tyne , UK
| | - Sivesh K Kamarajah
- Department of Surgery, Freeman Hospital Newcastle upon Tyne , Newcastle upon Tyne , UK
| | | | | | - Alessandro Zerbi
- Department of Biomedical Sciences, Humanitas University , Pieve Emanuele , Italy
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - Giovanni Capretti
- Department of Biomedical Sciences, Humanitas University , Pieve Emanuele , Italy
- IRCCS Humanitas Research Hospital , Rozzano , Italy
| | - Elizabeth Pando
- Department of Surgery, Vall d’Hebron University Hospital , Barcelona , Spain
| | - Robert P Sutcliffe
- Department of Hepatopancreatobiliary Surgery, University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - Ravi Marudanayagam
- Department of Hepatopancreatobiliary Surgery, University Hospitals Birmingham NHS Foundation Trust , Birmingham , UK
| | - Giuseppe Kito Fusai
- Hepatopancreatobiliary and Liver Transplant Unit, Royal Free London , London , UK
| | | | - Bergthor Björnsson
- Department of Surgery in Linköping and Department of Biomedical and Clinical Sciences, Linköping University , Linköping , Sweden
| | | | | | - Fernando Burdio
- Department of Surgery, University Hospital del Mar , Barcelona , Spain
| | - Tobias Keck
- Department of Surgery, University Medical Centre Schleswig-Holstein , Campus Lübeck, Lübeck , Germany
| | - Thilo Hackert
- Department of Surgery, Heidelberg University Hospital , Heidelberg , Germany
| | - Bas Groot Koerkamp
- Department of Surgery, Erasmus Medical Centre , Rotterdam, the Netherlands
| | - Mathieu d’Hondt
- Department of Digestive and Hepatobiliary/Pancreatic Surgery, Groeninge Hospital , Kortrijk , Belgium
| | - Andrea Coratti
- Division of Oncological and Robotic General Surgery, Careggi University Hospital , Florence , Italy
| | - Patrick Pessaux
- Division of Hepato-Biliary and Pancreatic Surgery, Nouvel Hôpital Civil, University Hospital, Institut Hospitalo-Universitaire de Strasbourg , Strasbourg , France
| | - Andrea Pietrabissa
- Department of Surgery, Fondazione IRCCS Policlinico San Matteo , Pavia , Italy
| | | | - Marco V Marino
- General and Emergency Surgery Department, Azienda Ospedaliera Ospedali Riuniti Villa Sofia-Cervello , Palermo , Italy
- General Surgery Department, Istituto Villa Salus , Siracusa , Italy
| | - Quintus Molenaar
- Department of Surgery, UMC Utrecht Cancer Centre, University Medical Centre Utrecht , Utrecht , the Netherlands
| | - Vincent Yip
- Department of Hepatopancreatobiliary Surgery, Royal London Hospital, Barts Health NHS Trust , London , UK
| | - Marc Besselink
- Department of Surgery, Amsterdam UMC, University of Amsterdam, Cancer Centre Amsterdam , Amsterdam , the Netherlands
| | - Giovanni Ferrari
- Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda , Milan , Italy
| | - Mohammad Abu Hilal
- Department of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza , Brescia , Italy
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