First Four Years of a Nationwide Audit: Did Clinical Practice and Outcomes in Pancreatic Surgery Improve?

Abstract

Introducion: The Dutch Pancreatic Cancer Audit (DPCA) has been established to monitor and improve nationwide outcomes of pancreatic surgery. This study aimed to describe changes in clinical practice and outcomes of pancreatic surgery in the first four years of the DPCA. Methods: Consecutive patients who underwent pancreatoduodenectomy or distal pancreatectomy were registered in the mandatory nationwide DPCA. Results were analyzed in the time periods 2014-2015 and 2016-2017. Trends in patient, tumor, and treatment characteristics were assessed using univariable regression analyses. Short-term surgical outcomes were investigated using multilevel multivariable logistic regression analyses. Results: Out of 3508 patients, 2780 (79.2%) underwent pancreatoduodenectomy and 728 (20.8%) distal pancreatectomy. The median (IQR) annual hospital volume for pancreatoduodenectomy was 36 (28-44). Out of 19 centers, 17 performed ≥20 and 4 centers performed ≥40 pancreatoduodenectomies annually. Two low-volume hospitals stopped pancreatic surgery. Nationwide in-hospital mortality decreased from 3.6% to 2.8% (OR 0.65, 95%CI 0.43-0.98, p=0.04). Failure to rescue improved from 12.8% to 10.2% (OR 0.61, 95%CI 0.40-0.95, p=0.03). The rates of textbook outcome (59.0%), postoperative pancreatic fistula (ISGPS B/C, 14.8%), readmission (16.7%), and median hospital stay (11 days) did not change significantly. The use of neoadjuvant therapy (5.8% vs 10.4%, p<0.01) and minimally invasive pancreatoduodenectomy (6.7% vs 20.5%, p<0.01) increased whereas the use of adjuvant therapy (67.3%) did not change. Conclusion: Considerable changes were noted in the first four years of the DPCA, including improved in-hospital mortality and failure to rescue rates, and increased use of neoadjuvant therapy and minimally invasive pancreatoduodenectomy.