The following is a summary of “Achieving an optimal textbook outcome following pancreatic resection: The impact of surgeon specific experience in achieving high quality outcomes,” published in the MARCH 2023 issue of Surgery by Chen, et al.
Little was known about the factors influencing the ability to achieve a textbook outcome (TO) after pancreatic surgery, including patient, procedural, and provider-level factors.
The study utilized the Medicare Standard Analytical Files from 2013 to 2017 to identify beneficiaries who underwent pancreatic surgery. Multivariable logistic regression with mixed effects was performed to evaluate the role of individual surgeons relative to patient- and procedure-related factors in achieving a TO.
The study included 20,902 patients who underwent pancreatic resection, with a median age of 72 years (IQR: 68-77), 47.4% were female, and the majority were White (89.3%). After adjusting for the patient- and procedure-related characteristics, there was a 35% variation in the odds of experiencing a TO relative to the specific individual surgeon who operated (OR: 1.35, 95% CI: 1.29-1.41). Patients who underwent pancreatectomy by a bottom TO quartile surgeon had a higher observed/expected ratio for each component of TO, including postoperative complication (OR: 2.62, 95% CI: 2.11-3.25), prolonged LOS (OR: 3.36, 95% CI: 2.67-4.22), 90-day readmission (OR: 2.08, 95% CI: 1.68-2.56), and 90-day mortality (OR: 3.29, 95% CI: 2.35-4.63), compared to patients treated by a high TO quartile surgeon.
The study found that the likelihood of achieving a TO after pancreatic resection was significantly influenced by the individual treating surgeon, even after controlling for the patient- and procedure-level factors.