Variation in hospital mortality after pancreatoduodenectomy is related to failure to rescue rather than major complications: a nationwide audit |
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| Authors: | Lennart B. van Rijssen Maurice J. Zwart Susan van Dieren Thijs de Rooij Bert A. Bonsing Koop Bosscha Ronald M. van Dam Casper H. van Eijck Michael F. Gerhards Josephus J. Gerritsen Erwin van der Harst Ignace H. de Hingh Koert P. de Jong Geert Kazemier Joost Klaase Berendina M. van der Kolk Cornelis J. van Laarhoven Misha D. Luyer Peter P. Coene |
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| Affiliation: | 1. Department of Surgery, Cancer Center Amsterdam, Academic Medical Center, Amsterdam, The Netherlands;2. Clinical Research Unit, Academic Medical Center, Amsterdam, The Netherlands;3. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands;4. Department of Surgery, Jeroen Bosch Hospital, ''s Hertogenbosch, The Netherlands;5. Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands;6. Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands;7. Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands;8. Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands;9. Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands;10. Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands;11. Department of Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands;12. Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands;13. Department of Surgery, Radboud University Medical Center, The Netherlands;14. Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands;15. Department of Surgery, Isala Clinics, Zwolle, The Netherlands;16. Department of Surgery, Tjongerschans Hospital, Heerenveen, The Netherlands;17. Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands;18. Department of Surgery, Amphia Hospital, Breda, The Netherlands;19. Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands |
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| Abstract: | BackgroundIn the mandatory nationwide Dutch Pancreatic Cancer Audit, rates of major complications and Failure to Rescue (FTR) after pancreatoduodenectomy between low- and high-mortality hospitals are compared, and independent predictors for FTR investigated.MethodsPatients undergoing pancreatoduodenectomy in 2014 and 2015 in The Netherlands were included. Hospitals were divided into quartiles based on mortality rates. The rate of major complications (Clavien-Dindo ≥3) and death after a major complication (FTR) were compared between these quartiles. Independent predictors for FTR were identified by multivariable logistic regression analysis.ResultsOut of 1.342 patients, 391 (29%) developed a major complication and in-hospital mortality was 4.2%. FTR occurred in 56 (14.3%) patients. Mortality was 0.9% in the first hospital quartile (4 hospitals, 327 patients) and 8.1% in the fourth quartile (5 hospitals, 310 patients). The rate of major complications increased by 40% (25.7% vs 35.2%) between the first and fourth hospital quartile, whereas the FTR rate increased by 560% (3.6% vs 22.9%). Independent predictors of FTR were male sex (OR = 2.1, 95%CI 1.2–3.9), age >75 years (OR = 4.3, 1.8–10.2), BMI ≥30 (OR = 2.9, 1.3–6.6), histopathological diagnosis of periampullary cancer (OR = 2.0, 1.1–3.7), and hospital volume <30 (OR = 3.9, 1.6–9.6).ConclusionsVariations in mortality between hospitals after pancreatoduodenectomy were explained mainly by differences in FTR, rather than the incidence of major complications. |
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