PANCREATICODUODENECTOMY OUTCOMES: THERE IS NO "I" IN TEAM
Jessica C. Heard*1, Jashwanth Karumuri1, Manal Fasih2, Houssam Osman1,2, D Rohan Jeyarajah1,2
1Hepatobilary Surgery, Methodist Richardson Medical Center, Richardson, TX; 2TCU Burnett School of Medicine, Fort Worth, TX
INTRODUCTION: Previous studies have shown a clear volume-outcome relationship with the performance of pancreaticoduodenectomy (PD). Specifically, both surgeon and hospital volume are known to have a significant impact on morbidity, mortality, and cost. Additionally, studies have shown high volume anesthesiologists had fewer postoperative complications after complex gastrointestinal surgery. There has never been a study primarily assessing the impact of surgeon-anesthesiologist team volume on intraoperative and postoperative outcomes in PDs. The purpose of this work is to examine this relationship.
METHODS: This is a retrospective review of consecutive patients who underwent PD between July 2020 and December 2021 at a single, high-volume hybrid institution where Enhanced Recovery After Surgery (ERAS) protocols have been instituted. Teams were considered high-volume (HV) if both the surgeon and anesthesiologist completed at least 10 PDs during the study period. Teams with either member completing fewer than 10 cases were regarded as low-volume (LV). The primary outcome was clinically-relevant postoperative pancreatic fistula (CR-POPF) formation. Secondary outcomes were the duration of anesthesia, intensive care unit (ICU) admission and length of stay (LOS), and overall complications.
RESULTS: 3 attending surgeons and 11 anesthesiologists completed 98 PDs during the study period. 71 (72.4%) cases were performed by HV teams. No significant differences in patient characteristics were present between groups (Table 1). Table 2 displays the intraoperative and postoperative measures.
The median duration of anesthesia was 36 minutes longer for the LV cohort (p = 0.059). Intraoperative hypotension was common among both groups. While there were no differences in the frequency or the duration of hypotension between groups, LV teams were statistically less likely to utilize intraoperative vasopressors (45.1% vs 22.2%, p = 0.038). There was no association between vasopressor use and development of a CR-POPF (p = 0.695).
The rate of ICU admission was similar between groups (p = 0.545), but the median LOS for patients of LV teams was twice that of HV teams (p = 0.340). 16 (22.8%) patients within the HV cohort and 5 (18.5%) in the LV cohort developed a CR-POPF (p = 0.642). There was no difference in the distribution of overall postoperative complications or total hospital LOS between volume groups.
CONCLUSIONS: This is the only study to date to examine PD operative outcomes as a product of the surgeon-anesthesiologist team volume. There was no difference in CR-POPF development based on team volume. HV teams were associated with a notably shorter duration of anesthesia and ICU LOS. Future work with a larger study population will help delineate the impact of HV teams on PD outcomes.
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