@article{2adb18e87f6f464fb26eef01853b7d8c,
title = "Surgeon experience contributes to improved outcomes in pancreatoduodenectomies at high risk for fistula development",
abstract = "Background: Pancreatoduodenectomies at high risk for clinically relevant pancreatic fistula are uncommon, yet intimidating, situations. In such scenarios, the impact of individual surgeon experience on outcomes is poorly understood. Methods: The fistula risk score was applied to identify high-risk patients (fistula risk score 7–10) from 7,706 pancreatoduodenectomies performed at 18 international institutions (2003–2020). For each case, surgeon pancreatoduodenectomy career volume and years of practice were linked to intraoperative fistula mitigation strategy adoption and outcomes. Consequently, best operative approaches for clinically relevant pancreatic fistula prevention and best performer profiles were identified through multivariable analysis models. Results: Eight hundred and thirty high-risk pancreatoduodenectomies, performed by 64 surgeons, displayed an overall clinically relevant pancreatic fistula rate of 33.7%. Clinically relevant pancreatic fistula rates decreased with escalating surgeon career pancreatoduodenectomy (–49.7%) and career length (–41.2%; both P <.001), as did transfusion and reoperation rates, postoperative morbidity index, and duration of stay. Great experience (≥400 pancreatoduodenectomies performed or ≥21-year-long career) was a significant predictor of clinically relevant pancreatic fistula prevention (odds ratio 0.52, 95% confidence interval 0.35–0.76) and was more often associated with pancreatojejunostomy reconstruction and prophylactic octreotide omission, which were both independently associated with clinically relevant pancreatic fistula reduction. A risk-adjusted performance analysis also correlated with experience. Moreover, minimizing blood loss (≤400 mL) significantly contributed to clinically relevant pancreatic fistula prevention (odds ratio 0.40, 95% confidence interval 0.22–0.74). Conclusion: Surgeon experience is a key contributor to achieve better outcomes after high-risk pancreatoduodenectomy. Surgeons can improve their performance in these challenging situations by employing pancreatojejunostomy reconstruction, omitting prophylactic octreotide, and minimizing blood loss.",
author = "{Pancreas Fistula Study Group} and Fabio Casciani and Trudeau, {Maxwell T.} and Asbun, {Horacio J.} and Ball, {Chad G.} and Claudio Bassi and Behrman, {Stephen W.} and Berger, {Adam C.} and Bloomston, {Mark P.} and Callery, {Mark P.} and Christein, {John D.} and Massimo Falconi and {Fernandez-del Castillo}, Carlos and Dillhoff, {Mary E.} and Dickson, {Euan J.} and Elijah Dixon and Fisher, {William E.} and House, {Michael G.} and Hughes, {Steven J.} and Kent, {Tara S.} and Giuseppe Malleo and Stefano Partelli and Salem, {Ronald R.} and Stauffer, {John A.} and Wolfgang, {Christopher L.} and Zureikat, {Amer H.} and Vollmer, {Charles M.} and {Van Buren}, George and Pratt, {Wande B.} and Watkins, {Ammara A.} and Beane, {Joal D.} and Javed, {Ammar A.} and Poruk, {Katherine E.} and Soares, {Kevin C.} and Vicente Valero and Fong, {Zhi V.} and Dilhoff, {Mary E.} and Haverick, {Ericka N.} and Schmidt, {Carl R.} and Hollis, {Robert H.} and Drebin, {Jeffrey A.} and Brett Ecker and Russell Lewis and Matthew McMillan and Benjamin Miller and Priya Puri and Thomas Seykora and Sprys, {Michael J.} and Kowalsky, {Stacy J.} and Laura Maggino and Roberto Salvia",
note = "Funding Information: We would like to recognize the following members of the PFSG and their respective institutions for their leadership, data acquisition, and noteworthy contributions to this collaborative effort. Baylor College of Medicine, William E. Fisher, MD; George Van Buren II, MD, Beth Israel Deaconess Medical Center, Harvard Medical School, Mark P. Callery, MD; Tara S. Kent, MD; Wande B. Pratt, MD; Charles M. Vollmer, Jr, MD; Ammara A. Watkins, MD, Indiana University School of Medicine, Michael G. House, MD; Joal D. Beane, MD, Jefferson Medical College, Adam C. Berger, MD, Johns Hopkins School of Medicine, Christopher L. Wolfgang, MD, PhD; Ammar A. Javed, MD; Katherine E. Poruk, MD; Kevin C. Soares, MD; Vicente Valero, III, MD, Massachusetts General Hospital, Harvard Medical School, Carlos Fernandez-del Castillo, MD; Zhi V. Fong, MD, Mayo Clinic - Jacksonville, Horacio J. Asbun, MD; John A. Stauffer, MD, The Ohio State University Wexner Medical Center, Mark P. Bloomston, MD; Mary E. Dilhoff, MD; Ericka N. Haverick, BSN; Carl R. Schmidt, MD, University of Alabama at Birmingham School of Medicine, John D. Christein, MD; Robert H. Hollis, MD, University of Calgary, Chad G. Ball, MD; Elijah Dixon, MD, University of Florida College of Medicine, Steven J. Hughes, MD, University of Pennsylvania, Perelman School of Medicine, Charles M. Vollmer, Jr, MD; Jeffrey A. Drebin, MD, PhD; Brett Ecker, MD; Russell Lewis, Jr, MD; Matthew McMillan, BA; Benjamin Miller, DO; Priya Puri, BA; Thomas Seykora, BA; Michael J. Sprys, MS, University of Pittsburgh Medical Center, Amer H. Zureikat, MD; Stacy J. Kowalsky, MD, University of Tennessee Health Science Center, Stephen W. Behrman, MD, University of Verona, Claudio Bassi, MD; Fabio Casciani, MD; Laura Maggino, MD; Giuseppe Malleo, MD PhD; Roberto Salvia, MD PhD; Giulia Savegnago, MD, Vita-Salute San Raffaele University, Milan, Italy, Lorenzo Cinelli, MD; Massimo Falconi, MD; Stefano Partelli, MD PhD, West of Scotland Pancreatic Unit, Glasgow Royal Infirmary, Euan J. Dickson, MD; Nigel B. Jamieson, MD; Lavanniya K. P. Velu, MD, Yale School of Medicine, Ronald R. Salem, MD; John W. Kunstman, MD Publisher Copyright: {\textcopyright} 2020 Elsevier Inc.",
year = "2021",
month = apr,
doi = "10.1016/j.surg.2020.11.022",
language = "English (US)",
volume = "169",
pages = "708--720",
journal = "Surgery (United States)",
issn = "0039-6060",
publisher = "Mosby Inc.",
number = "4",
}