Feasibility and Safety of a “Shared Care” Model in Complex Operation: A 5-Year Analysis of Pancreaticoduodenectomy

Abstract

INTRODUCTION: Shared care, in which interchangeable surgeons deliver clinical service, has been proposed to improve efficiency in surgical systems. This study aimed to elucidate the feasibility and safety of shared care models in complex hepatopancreatobiliary (HPB) operation. METHODS: Patients who underwent elective pancreaticoduodenectomy between 2016 and 2020 were included. Shared care measures, including the mean number of HPB surgeons during a patient’s care cycle, consenting surgeon different from primary operating surgeon (POS), first encounter with the POS at time of operation, and cases involving co-operation (more than one attending surgeon during operation), were analyzed. A care cycle was defined as the 1-year pre- to 1-year post-pancreaticoduodenectomy period. Primary patient outcomes (Figure) were collected from the institution’s NSQIP database and compared with the risk-adjusted population rate from the NSQIP Collaborative.FigureRESULTS: A total of 174 patients were included. An average of 3.0 surgeons were involved throughout the patients’ care cycle, 120 (69.0%) patients had different consenting surgeons vs POS, and 100 (57.5%) first met their POS at time of operation. Co-operation occurred for 137 (78.7%) patients. Death within 30 days occurred in 2 (1.1%), unplanned return to operating room in 13 (7.5%), sepsis in 9 (5.2%), and surgical site infection in 66 (17.2%). All corresponding risk-adjusted rates from the NSQIP Collaborative were within the 95% CI of the institution’s rate except for sepsis (Figure). CONCLUSION: Shared care is feasible in complex operation without compromising patient safety. Wider adoption may be encouraged to further address bottlenecks in surgical systems and promote support and collaboration between surgeons.