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Back to 2015 Annual Meeting Program Perception Is Reality: Quality Metrics in Pancreatic Surgery- a Central Pancreas Consortium (Cpc) Analysis of 1399 Patients Daniel E. Abbott*1, David Kooby2, Nipun Merchant3, Malcolm H. Squires2, Shishir K. Maithel2, Sharon M. Weber4, Emily Winslow4, Clifford S. Cho4, David J. Bentrem5, Hong Jin Kim6, Charles R. Scoggins7, Robert C. Martin7, Alex Parikh3, William G. Hawkins8, Grace E. Martin1, Syed Ahmad1 1Surgery, The University of Cincinnati Medical Center, Cincinnati, OH; 2Surgery, Emory University, Atlanta, GA; 3Surgery, Vanderbilt University, Nashville, TN; 4Surgery, University of Wisconsin, Madison, WI; 5Surgery, Northwestern University, Chicago, IL; 6Surgery, University of North Carolin, Chapel Hill, NC; 7Surgery, University of Louisville, Louisville, KY; 8Surgery, Washington University, St Louis, MO Introduction: Because variability in outcomes exists between centers performing pancreatic surgery, several groups have defined quality metrics that identify centers delivering quality care. Although these metrics are perceived to be associated with good outcomes, their relationship with actual outcomes has not been established. Methods: We surveyed a national cadre of pancreatic surgeons regarding perceived quality metrics. The performance of these metrics were then evaluated against the database of eight high volume institutions to determine how often they were being performed and when possible their relationship with long-term outcomes. Results: Overall, 103 pancreatic surgeons responded to the survey. Based on this, the top five important metrics were perceived to be multidisciplinary care, case volume, mortality rates, margin status, and complications rates. Other factors included rate of LN harvest and timing of adjuvant therapy. Subsequent analysis using the multi-institutional dataset of 1399 patients demonstrated that all institutions had the availability of a multidisciplinary team and supporting infrastructure, including institutional monitoring of surgeon and center outcomes. For the entire cohort, median survival was 19.7 months and perioperative mortality was 2.9%. A R0 retroperitoneal and neck margin was obtained in 81% (n=1109) and 91.4% (n=1278) of cases, respectively. 78% of patients (n=1091) had greater than 10 lymph nodes harvested, and LN positivity was present in 71% (n=902). 74% (n=960) of patients received adjuvant therapy within 60 days of surgery. Multivariate analysis demonstrated margin status, identification of greater than 10 lymph nodes, nodal positivity, and delivery of adjuvant therapy within 60 days to be associated with improved overall survival. Conclusions: These analyses demonstrate that systematic monitoring of surgeons' perceived quality metrics provides critical prognostic information, which is associated with improved patient survival. Conducting and documenting such metrics can identify centers delivering high quality care. Back to 2015 Annual Meeting Program |
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