HOSPITAL MORTALITY IN PANCREATIC SURGERY - RESULTS OF A MULTICENTER OBSERVATIONAL STUDY
Frank Meyer*1, Ingo Gastinger2, Henry Ptok1, Hans Lippert2, Henning Dralle3
1Department of General, Abdominal, Vascular and Transplant Surgery, University Hospital of Magdeburg, Magdeburg, Germany; 2Institute of Quality Assurance in Operative Medicine, Otto-von-Guericke University at Magdeburg, Magdeburg, Germany; 3Section of Endocrine Surgery, Dept. of General, Visceral and Transplantation Surgery, Medical Center, Essen, Germany
The rate of hospital mortality (in-hospital mortality) after complex pancreatic resections cannot be used as only decision-making criterion with no further analysis and specification. Such analysis has to provide a risk-adjusted benchmarking including a continuous evaluation taking into account the frequency of a surgical procedure and its competent perioperative management.
Material and Methods: As part of the Prospective Evaluation study Elective Pancreatic surgery (PEEP), overall 2,003 patients were enrolled over a 3-year-time period from 01/01/2006 to 12/31/2008, who had been undergone elective pancreatic surgery in 27 surgical departments. In the study included were only hospitals which perform pancreatic resections. In addition to the analysis of the current situation of the operative treatment of pancreatic diseases, the complex aspects of the in-hospital mortality as a main outcome parameter were investigated.
Results: Out of all enrolled patients (n=2,003), 75 patients (3.7 %) died during their hospital stay. In the group of the 1,045 partial pancreaticoduodenectomies (PD), 43 patients did not survive hospital stay (4.1 %). Similarly, such low hospital mortality rates were observed after total duodenopancreatectomy (3.8 %) and after left resection of the pancreas (1.9 %). With regard to a univariate risk stratification, advanced age and an ASA scoring of 3 and 4 had a significant impact to hospital mortality. Multivariate regression analysis within the PD group revealed increased need for blood transfusion and delay of oral feeding as factors closely associated with specific complications with a significant impact to hospital mortality. Significant differences of the hospital mortality rates were found comparing hospital volume groups such as 10 - 20 vs. > 20 cases / year for the 831 Kausch-Whipple procedures in adenocarcinoma and chronic pancreatitis.
Discussion: An adequate hospital mortality rate revealed in the continuous benchmarking represents an acceptable quality level of structural and therapeutic predictions in pancreatic resections. The participation of surgical departments with complex oncosurgical interventions in clinical multicenter observational studies as a contribution to research on surgical care appears reasonable and recommendable since the results of such studies can provide an impact to decision-making processes in daily surgical practice.
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