Variation in hospital mortality after pancreatoduodenectomy is related to failure to rescue rather than major complications: a nationwide audit

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Title:	Variation in hospital mortality after pancreatoduodenectomy is related to failure to rescue rather than major complications: a nationwide audit
Author(s):	Rijssen, L.B. van; Zwart, M.J.; Dieren, S. van; Rooij, T. de; Bonsing, B.A.; Bosscha, K.; Dam, R.M. van; Eijck, C.H. van; Gerhards, M.F.; Gerritsen, J.J.; Harst, E; Hingh, I.H. de; Jong, K.P. de; Kazemier, G.; Klaase, J.; Kolk, B.M. van der ; Laarhoven, C.J.H.M. van ; Luyer, M.D.; Molenaar, I.Q.; Patijn, G.A.; Rupert, C.G.; Scheepers, J.J.; Schelling, G.P. van der; Vahrmeijer, A.L.; Busch, O.R.; Santvoort, H.C. van; Koerkamp, B. Groot; Besselink, M.G.H.
Publication year:	2018
Source:	Hpb, vol. 20, iss. 8, (2018), pp. 759-767
ISSN:	1365-182X
DOI:	https://doi.org/10.1016/j.hpb.2018.02.640
Publication type:	Article / Letter to editor
Please use this identifier to cite or link to this item : http://hdl.handle.net/2066/195692
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Subject:	Radboudumc 14: Tumours of the digestive tract RIHS: Radboud Institute for Health Sciences Radboudumc 18: Healthcare improvement science RIHS: Radboud Institute for Health Sciences
Organization:	Intensive Care Surgery Radboudumc Extern
Journal title:	Hpb
Volume:	vol. 20
Issue:	iss. 8
Page start:	p. 759
Page end:	p. 767
Abstract:	BACKGROUND: In 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. METHODS: Patients 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. RESULTS: Out 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). CONCLUSIONS: Variations in mortality between hospitals after pancreatoduodenectomy were explained mainly by differences in FTR, rather than the incidence of major complications.