Complications and failure-to-rescue after pancreatectomy and hospital participation in the targeted American College of Surgeons National Surgical Quality Improvement Program registry

Abstract

Background: More than 700 hospitals participate in the American College of Surgeons National Surgical Quality Improvement Program, but most pancreatectomies are performed in 165 centers participating in the pancreas procedure-targeted registry. We hypothesized that these hospitals ("targeted hospitals") might provide more specialized care than those not participating ("standard hospitals").

Methods: The 2014 to 2019 pancreas-targeted and standard American College of Surgeons National Surgical Quality Improvement Program registry were reviewed regarding patient demographics, comorbidities, and perioperative outcomes using standard univariate and multivariable logistic regression analyses. Primary outcomes included 30-day mortality and serious morbidity.

Results: The registry included 30,357 pancreatoduodenectomies (80% in targeted hospitals) and 14,800 distal pancreatectomies (76% in targeted hospitals). Preoperative and intraoperative characteristics of patients treated at targeted versus standard hospitals were comparable. On multivariable analysis, pancreatoduodenectomies performed at targeted hospitals were associated with a 39% decrease in 30-day mortality (odds ratio, 0.61; 95% confidence interval, 0.50-0.75), 17% decrease in serious morbidity (odds ratio, 0.83; 95% confidence interval, 0.77-0.89), and 41% decrease in failure-to-rescue (odds ratio, 0.59; 95% confidence interval, 0.47-0.74). These differences did not apply to distal pancreatectomies. Participation in the targeted registry was associated with higher rates of optimal surgery for both pancreatoduodenectomy (odds ratio, 1.33; 95% confidence interval, 1.25-1.41) and distal pancreatectomy (odds ratio, 1.17; 95% confidence interval, 1.06-1.30).

Conclusion: Mortality and failure-to-rescue rates after pancreatoduodenectomy in targeted hospitals were nearly half of rates in standard American College of Surgeons National Surgical Quality Improvement Program hospitals. Further research should delineate factors underlying this effect and highlight opportunities for improvement.

Figure 1A –

30-day mortality for pancreatoduodenectomy (left) and distal pancreatectomy (right) in procedure-targeted and standard hospitals

Figure 1B –

Serious morbidity for pancreatoduodenectomy (left) and distal pancreatectomy (right) in procedure-targeted and standard hospitals

Figure 1C –

Failure-to-rescue for pancreatoduodenectomy (left) and distal pancreatectomy (right) in procedure-targeted and standard hospitals

Figure 1D –

Optimal surgery for pancreatoduodenectomy (left) and distal pancreatectomy (right) in procedure-targeted and standard hospitals * - p<0.001 vs standard † p<0.01 vs Standard Patients undergoing pancreatectomy in hospitals participating in the pancreas-targeted ACS NSQIP registry had significantly lower risked-adjusted morbidity, mortality, and failure to rescue compared to hospitals participating in the standard ACS NSQIP registry. The importance of this finding is that hospitals who self-selected to invest on targeted registry participation had better outcomes and benchmarking against the pancreas-targeted ACS NSQIP registry outcomes should be done with caution.