Developing better practices at the institutional level leads to better outcomes after pancreaticoduodenectomy in 3,378 patients: domestic audit of the Japanese Society of Pancreatic Surgery

Sohei Satoi, Tomohisa Yamamoto, Hideyuki Yoshitomi, Fuyuhiko Motoi, Manabu Kawai, Tsutomu Fujii, Keita Wada, Hidehito Arimitsu, Masayuki Sho, Ippei Matsumoto, Satoshi Hirano, Hiroaki Yanagimoto, Masayuki Ohtsuka, Michiaki Unno, Hiroki Yamaue, Masanori Kon

Research output: Contribution to journalArticlepeer-review

5 Citations (Scopus)

Abstract

Background: The aim of the present study was to assess recent trends in pancreaticoduodenectomy (PD) and the role of institutional standardization on the development of postoperative complications in 3,378 patients who underwent PD in Japan. Methods: Data were collected from 3,378 patients who underwent PD in 2006, 2010 and 2014 at 53 institutions. A standardized institution (SI) was defined as one that implements ≥7 of 13 quality initiatives according to departmental policy. There were 1,223 patients in the SI group and 2,155 in the non-SI group. Clinical parameters were compared over time, and between groups. Risk factors for morbidity and mortality were assessed by logistic regression analysis with a mixed-effects model. Results: The number of patients who underwent PD in SIs increased from 16.5% in 2006 to 46.4% in 2014. The SI group experienced an improved process of care and a lower frequency of severe complications vs. the non-SI group (P < 0.001). Multivariate analysis revealed that the SI group was associated with a lower incidence of delayed gastric emptying (odds ratio −0.499, P = 0.008) and incisional surgical site infection (odds ratio −0.999, P < 0.001). Conclusion: Standardization of care in PD may be important in reducing post-PD complications, and is a critical element for improving clinical outcomes.

Original languageEnglish
Pages (from-to)501-510
Number of pages10
JournalJournal of Hepato-Biliary-Pancreatic Sciences
Volume24
Issue number9
DOIs
Publication statusPublished - 2017 Sep

Keywords

  • Pancreaticoduodenectomy
  • Postoperative complication mortality
  • Process of care
  • Quality indicator

ASJC Scopus subject areas

  • Medicine(all)

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