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ACHIEVING OPTIMAL OUTCOMES IN ROBOTIC PANCREATICODUODENECTOMY IN THE MODERN ERA: A CLINICAL VARIABLE ANALYSIS
Hasan Al Harakeh
*, Garnet Vanterpool, Iswanto Sucandy, Melanie Mendez, Kristina Milivojev Covilo, Sharona B. Ross
Digestive Health Institute, Advent Health Tampa, Tampa, FL
Background: The concept of "textbook outcomes (TO)," offers an objective and standardized measure to assess surgical performance and may serve as a quality marker of the surgical service offered to patients.This study aims to evaluate the achievement of TO in robotic pancreaticoduodenectomy (PD) at our institution and explore the relationship between clinical variables and previously defined operative success parameters.
Methods: With Institutional Review Board (IRB) approval, a retrospective analysis of our prospectively kept database was conducted on all patients (135) who underwent robotic PD operations between January, 2021 and June, 2024. The criteria for defining a textbook outcome were the absence of (1) in-hospital mortality, (2) severe complications—Clavien-Dindo > 3, (3) postoperative pancreatic fistula—International Study Group of Pancreatic Surgery (ISGPS) grade B/C, (4) reoperation, (5) hospital stay >75th, and (6) readmission within 30 days. Continuous variables are reported as median (mean ± standard deviation) for clarity and comparison. Statistical analyses were performed to assess the relationship between clinical variables and the achievement of TOs, with a p-value of ? 0.05 considered statistically significant.
Results: A total of 135 patients underwent robotic PDs, of which 93 (68%) operations achieved TO. The TO cohort and those who did not achieve TO had a median age of 71 years. Patients in the TO cohort were 48% men and 52% women, compared to 62% men and 38% women in the non-TO cohort. The BMI for the TO and non-TO cohorts was [26 (26±5.1) vs. 27 (28±5.05), p=0.04] respectively. Comorbidities including, diabetes mellitus, renal failure and chronic obstructive pulmonary diseases were more prevalent in the cohort who achieved TO.
Patients who did not achieve TO had more postoperative complications (48% vs. 1%, p<0.001), with complications of the TO cohort being Clavien-Dindo < 2. Patients who did not achieve TO had a longer length of stay (LOS) [5 (5±1.16) vs. 6 (10±11.04), p<0.001]. Our overall mortality was 4% patients who did not achieve TO had a higher percentage of 30, 60, and 90-day mortality (1% vs 12%, p=0.005 ; 3% vs. 17%, p= 0.006; 3% vs. 17%, p=0.006).
Conclusion: Our data support that achieving textbook outcomes in robotic PD reflects significantly improved clinical results, including reduced postoperative complications, shorter hospital stays, lower readmission rates, and improved survival. Identifying the clinical variables linked to TO can improve the predictability of outcomes and hence guide surgical decision-making and patient counseling.
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