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 

作者机构：Department of SurgeryUniversity of the West IndiesSt Augustine 000000Trinidad and Tobago Department of SurgeryFaculty of MedicineUniversity of CalgaryCalgaryAlberta T2N2T9Canada Department of SurgeryWeill Cornell Medical CollegeNew YorkNY 10065United States Department of Surgical OncologyTata Memorial CenterHomi Bhabha National UniversityMumbai 400012India Department of SurgeryManchester Royal InfirmaryManchester M139WLUnited Kingdom University Surgical UnitSouthampton General HospitalSouthampton SO166YDUnited Kingdom Department of SurgeryUniversity of the West IndiesNassau N-1184Bahamas Department of SurgeryMorehouse School of MedicineAtlantaGA 30310United States Department of SurgeryGeneral Hospital in Port of SpainPort of Spain 000000Trinidad and Tobago 

出 版 物：《World Journal of Gastrointestinal Surgery》 (世界胃肠外科杂志（英文版）（电子版）)

年 卷 期：2024年第16卷第3期

页      面：681-688页

核心收录：

学科分类：1002[医学-临床医学] 100210[医学-外科学(含：普外、骨外、泌尿外、胸心外、神外、整形、烧伤、野战外)] 10[医学] 

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

主　　题：Pancreas Complication Rescue Failure Morbidity Mortality Pancreaticoduodenectomy 

摘      要：BACKGROUND Pancreaticoduodenectomy(PD)is a technically complex operation,with a re-latively high risk for *** ability to rescue patients from post-PD complications is as a recognized quality *** protocols were instituted at our low volume facility in the year *** To document the rate of rescue from post-PD complications with tailored protocols in place as a measure of *** 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,***-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 *** 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 *** 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 ***(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 *** low volumes at our facility,we demonstrated that 87.9%of patients were rescued from major *** 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 protoc