Optimal Pancreatic Surgery
14:50 - 15:20, Room 104 (104講堂)
Abstract - Optimal pancreatic surgery
The American College of Surgeons-National Surgical Quality Improvement Program (ACS-NSQIP) was initiated in 2005. Within a few years, two-thirds of participating hospitals experienced reduced postoperative morbidity, and 82% of hospitals had reductions in mortality. By 2010, a risk calculator has been developed, and pancreatectomy-specific outcomes had been defined. In 2012, a Pancreatectomy Demonstration Project was accomplished at 43 hospitals with 24 procedure-specific variables including pancreatic fistula, delayed gastric emptying and pathology. In 2015, a Hepato-Pancreato-Biliary (HPB) Collaborative was initiated. By 2019, 165 hospitals in the USA (148), Canada (12), Australia (2), Lebanon (1), Jordan (1) and Singapore (1) were participating in the HPB Collaborative. In 2018, data on over 6,000 pancreatectomies were risk-adjusted and fed back to the participating hospitals. Multiple research papers have been published from the Demonstration Project as well as from the Participant Use File. One recent analysis in patients undergoing pancreatoduodenectomy (PD) demonstrated improved outcomes when drains were removed by postoperative day (POD) 3 when drain fluid amylase on POD 1 (DFA-1) was low. Another recent study in PD patients documented that superficial surgical site infections were reduced when a wound protector, a midline incision and broad-spectrum prophylactic antibiotics were utilized. Most recently, optimal pancreatic surgery was defined as no mortality, no serious morbidity, no need for postoperative percutaneous drainage or reoperation, a length of stay (LOS) below the 75th percentile and no readmission. From 2014-17, optimal surgery improved significantly (p<0.01) for both pancretoduodenectomy and distal pancreatectomy. Significant improvements in mortality, morbidity, percutaneous drainage, LOS and readmissions all contributed to the desirable outcomes.