Can trainees safely perform pancreatoenteric anastomosis? A systematic review, meta-analysis, and risk-adjusted analysis of postoperative pancreatic fistula
(2022) In Surgery (United States) 172(1). p.319-328- Abstract
Background: The complexity of pancreaticoduodenectomy and fear of morbidity, particularly postoperative pancreatic fistula, can be a barrier to surgical trainees gaining operative experience. This meta-analysis sought to compare the postoperative pancreatic fistula rate after pancreatoenteric anastomosis by trainees or established surgeons. Methods: A systematic review of the literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with differences in postoperative pancreatic fistula rates after pancreatoenteric anastomosis between trainee-led versus consultant/attending surgeons pooled using meta-analysis. Variation in rates of postoperative pancreatic fistula was further explored... (More)
Background: The complexity of pancreaticoduodenectomy and fear of morbidity, particularly postoperative pancreatic fistula, can be a barrier to surgical trainees gaining operative experience. This meta-analysis sought to compare the postoperative pancreatic fistula rate after pancreatoenteric anastomosis by trainees or established surgeons. Methods: A systematic review of the literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with differences in postoperative pancreatic fistula rates after pancreatoenteric anastomosis between trainee-led versus consultant/attending surgeons pooled using meta-analysis. Variation in rates of postoperative pancreatic fistula was further explored using risk-adjusted outcomes using published risk scores and cumulative sum control chart analysis in a retrospective cohort. Results: Across 14 cohorts included in the meta-analysis, trainees tended toward a lower but nonsignificant rate of all postoperative pancreatic fistula (odds ratio: 0.77, P =.45) and clinically relevant postoperative pancreatic fistula (odds ratio: 0.69, P =.37). However, there was evidence of case selection, with trainees being less likely to operate on patients with a pancreatic duct width <3 mm (odds ratio: 0.45, P =.05). Similarly, analysis of a retrospective cohort (N = 756 cases) found patients operated by trainees to have significantly lower predicted all postoperative pancreatic fistula (median: 20 vs 26%, P <.001) and clinically relevant postoperative pancreatic fistula (7 vs 9%, P =.020) rates than consultant/attending surgeons, based on preoperative risk scores. After adjusting for this on multivariable analysis, the risks of all postoperative pancreatic fistula (odds ratio: 1.18, P =.604) and clinically relevant postoperative pancreatic fistula (odds ratio: 0.85, P =.693) remained similar after pancreatoenteric anastomosis by trainees or consultant/attending surgeons. Conclusion: Pancreatoenteric anastomosis, when performed by trainees, is associated with acceptable outcomes. There is evidence of case selection among patients undergoing surgery by trainees; hence, risk adjustment provides a critical tool for the objective evaluation of performance.
(Less)
- author
- author collaboration
- organization
- publishing date
- 2022
- type
- Contribution to journal
- publication status
- published
- subject
- in
- Surgery (United States)
- volume
- 172
- issue
- 1
- pages
- 319 - 328
- publisher
- Elsevier
- external identifiers
-
- scopus:85125443030
- pmid:35221107
- ISSN
- 0039-6060
- DOI
- 10.1016/j.surg.2021.12.033
- language
- English
- LU publication?
- yes
- id
- 74943484-65ce-44cb-871a-565fc418111a
- date added to LUP
- 2022-04-25 15:02:13
- date last changed
- 2024-06-13 12:06:07
@article{74943484-65ce-44cb-871a-565fc418111a,
abstract = {{<p>Background: The complexity of pancreaticoduodenectomy and fear of morbidity, particularly postoperative pancreatic fistula, can be a barrier to surgical trainees gaining operative experience. This meta-analysis sought to compare the postoperative pancreatic fistula rate after pancreatoenteric anastomosis by trainees or established surgeons. Methods: A systematic review of the literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with differences in postoperative pancreatic fistula rates after pancreatoenteric anastomosis between trainee-led versus consultant/attending surgeons pooled using meta-analysis. Variation in rates of postoperative pancreatic fistula was further explored using risk-adjusted outcomes using published risk scores and cumulative sum control chart analysis in a retrospective cohort. Results: Across 14 cohorts included in the meta-analysis, trainees tended toward a lower but nonsignificant rate of all postoperative pancreatic fistula (odds ratio: 0.77, P =.45) and clinically relevant postoperative pancreatic fistula (odds ratio: 0.69, P =.37). However, there was evidence of case selection, with trainees being less likely to operate on patients with a pancreatic duct width <3 mm (odds ratio: 0.45, P =.05). Similarly, analysis of a retrospective cohort (N = 756 cases) found patients operated by trainees to have significantly lower predicted all postoperative pancreatic fistula (median: 20 vs 26%, P <.001) and clinically relevant postoperative pancreatic fistula (7 vs 9%, P =.020) rates than consultant/attending surgeons, based on preoperative risk scores. After adjusting for this on multivariable analysis, the risks of all postoperative pancreatic fistula (odds ratio: 1.18, P =.604) and clinically relevant postoperative pancreatic fistula (odds ratio: 0.85, P =.693) remained similar after pancreatoenteric anastomosis by trainees or consultant/attending surgeons. Conclusion: Pancreatoenteric anastomosis, when performed by trainees, is associated with acceptable outcomes. There is evidence of case selection among patients undergoing surgery by trainees; hence, risk adjustment provides a critical tool for the objective evaluation of performance.</p>}},
author = {{Pande, Rupaly and Halle-Smith, James M. and Thorne, Thomas and Hiddema, Lydia and Hodson, James and Roberts, Keith J. and Arshad, Ali and Connor, Saxon and Conlon, Kevin C.P. and Dickson, Euan J. and Giovinazzo, Francesco and Harrison, Ewen and de Liguori Carino, Nicola and Hore, Todd and Knight, Stephen R. and Loveday, Benjamin and Magill, Laura and Mirza, Darius and Pandanaboyana, Sanjay and Perry, Rita J. and Pinkney, Thomas and Siriwardena, Ajith K. and Satoi, Sohei and Skipworth, James and Stättner, Stefan and Sutcliffe, Robert P. and Tingstedt, Bobby}},
issn = {{0039-6060}},
language = {{eng}},
number = {{1}},
pages = {{319--328}},
publisher = {{Elsevier}},
series = {{Surgery (United States)}},
title = {{Can trainees safely perform pancreatoenteric anastomosis? A systematic review, meta-analysis, and risk-adjusted analysis of postoperative pancreatic fistula}},
url = {{http://dx.doi.org/10.1016/j.surg.2021.12.033}},
doi = {{10.1016/j.surg.2021.12.033}},
volume = {{172}},
year = {{2022}},
}