Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center:Value of tailored peri-pancreatectomy protocols  

作　　者：Shamir O Cawich Elijah Dixon Parul J Shukla Shailesh V Shrikhande Rahul R Deshpande Fawwaz Mohammed Neil W Pearce Wesley Francis Shaneeta Johnson Johann Bujhawan 

机构地区：[1]Department of Surgery,University of the West Indies,St Augustine 000000,Trinidad and Tobago [2]Department of Surgery,Faculty of Medicine,University of Calgary,Calgary,Alberta T2N2T9,Canada [3]Department of Surgery,Weill Cornell Medical College,New York,NY 10065,United States [4]Department of Surgical Oncology,Tata Memorial Center,Homi Bhabha National University,Mumbai 400012,India [5]Department of Surgery,Manchester Royal Infirmary,Manchester M139WL,United Kingdom [6]University Surgical Unit,Southampton General Hospital,Southampton SO166YD,United Kingdom [7]Department of Surgery,University of the West Indies,Nassau N-1184,Bahamas [8]Department of Surgery,Morehouse School of Medicine,Atlanta,GA 30310,United States [9]Department of Surgery,General Hospital in Port of Spain,Port of Spain 000000,Trinidad and Tobago

出　　处：《World Journal of Gastrointestinal Surgery》2024年第3期681-688,共8页世界胃肠外科杂志（英文版）（电子版）

基　　金：This study was approved by the Campus Research Ethics Committee,St.Augustine.

摘　　要：BACKGROUND Pancreaticoduodenectomy(PD)is a technically complex operation,with a re-latively high risk for complications.The ability to rescue patients from post-PD complications is as a recognized quality measure.Tailored protocols were instituted at our low volume facility in the year 2013.AIM To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of quality.METHODS A retrospective audit was performed to collect data from patients who experienced major post-PD complications at a low volume pancreatic surgery unit in Trinidad and Tobago between January 1,2013 and June 30,2023.Stan-dardized definitions from the International Study Group of Pancreatic Surgery were used to define post-PD complications,and the modified Clavien-Dindo classification was used to classify post-PD complications.RESULTS Over the study period,113 patients at a mean age of 57.5 years(standard deviation[SD]±9.23;range:30-90;median:56)underwent PDs at this facility.Major complications were recorded in 33(29.2%)patients at a mean age of 53.8 years(SD:±7.9).Twenty-nine(87.9%)patients who experienced major morbidity were salvaged after aggre-ssive treatment of their complication.Four(3.5%)died from bleeding pseudoaneurysm(1),septic shock secondary to a bile leak(1),anastomotic leak(1),and myocardial infarction(1).There was a significantly greater salvage rate in patients with American Society of Anesthesiologists scores≤2(93.3%vs 25%;P=0.0024).CONCLUSION This paper adds to the growing body of evidence that volume alone should not be used as a marker of quality for patients requiring PD.Despite low volumes at our facility,we demonstrated that 87.9%of patients were rescued from major complications.We attributed this to several factors including development of rescue protocols,the competence of the pancreatic surgery teams and continuous,and adaptive learning by the entire institution,cul-minating in the development of tailored peri-pancreatectomy protocols.

关 键 词：PANCREAS COMPLICATION RESCUE Failure MORBIDITY Mortality PANCREATICODUODENECTOMY 

分 类 号：R657.5[医药卫生—外科学]