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Pancreatic surgery outcomes : multicentre prospective snapshot study in 67 countries

Fusai, Guiseppe (2024) In The British journal of surgery 111(1).
Abstract

BACKGROUND: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.

METHODS: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other... (More)

BACKGROUND: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.

METHODS: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.

RESULTS: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 per cent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 per cent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 per cent; however, it was 41 per cent in low-to-middle- compared with 19 per cent in very high-HDI countries.

CONCLUSION: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761).

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author
contributor
LU ; LU ; LU orcid and LU
author collaboration
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Humans, Prospective Studies, Male, Female, Middle Aged, Postoperative Complications/epidemiology, Cross-Sectional Studies, Aged, Pancreatectomy/mortality, Treatment Outcome, Pancreatic Diseases/surgery, Adult
in
The British journal of surgery
volume
111
issue
1
article number
znad330
publisher
Oxford University Press
external identifiers
  • pmid:38743040
  • scopus:85182367836
ISSN
1365-2168
DOI
10.1093/bjs/znad330
language
English
LU publication?
yes
additional info
© The Author(s) 2023. Published by Oxford University Press on behalf of BJS Society Ltd.
id
62295584-654a-4644-81a5-41ee3389c296
date added to LUP
2024-09-30 13:02:42
date last changed
2024-10-01 12:01:57
@article{62295584-654a-4644-81a5-41ee3389c296,
  abstract     = {{<p>BACKGROUND: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide.</p><p>METHODS: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters.</p><p>RESULTS: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 per cent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 per cent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 per cent; however, it was 41 per cent in low-to-middle- compared with 19 per cent in very high-HDI countries.</p><p>CONCLUSION: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761).</p>}},
  author       = {{Fusai, Guiseppe}},
  issn         = {{1365-2168}},
  keywords     = {{Humans; Prospective Studies; Male; Female; Middle Aged; Postoperative Complications/epidemiology; Cross-Sectional Studies; Aged; Pancreatectomy/mortality; Treatment Outcome; Pancreatic Diseases/surgery; Adult}},
  language     = {{eng}},
  month        = {{01}},
  number       = {{1}},
  publisher    = {{Oxford University Press}},
  series       = {{The British journal of surgery}},
  title        = {{Pancreatic surgery outcomes : multicentre prospective snapshot study in 67 countries}},
  url          = {{http://dx.doi.org/10.1093/bjs/znad330}},
  doi          = {{10.1093/bjs/znad330}},
  volume       = {{111}},
  year         = {{2024}},
}