Abstract
BackgroundObserving cyclic patterns in surgical outcome is a common experience. We aimed to measure this phenomenon and to hypothesize possible causes using the experience of a high-volume pancreatic surgery department.MethodsOutcomes of 2748 patients who underwent a Whipple procedure at a single high-volume center from January 2000 to December 2018 were retrospectively analyzed. Three different hypotheses were tested: the effect of climate changes, the “July effect” and the effect of vacations.ResultsClavien-Dindo ≥ 3 morbidity was similar during warm vs. cold months (22.5% vs. 19.8%, p = 0.104) and at the beginning of activity of new trainees vs. the rest of the year (23.5 vs. 22.5%, p = 0.757). Patients operated when a high percentage of staff is on vacation showed an increased Clavien-Dindo ≥ 3 morbidity (22.3 vs. 18.5%, p = 0.022), but similar mortality (2.3 vs. 1.8%, p = 0.553). The surgical waiting list was also significantly longer during these periods (37 vs. 27 days, p = 0.037). Being operated in such a period of the year was an independent predictor of severe morbidity (OR 1.271, CI 95% 1.086–1.638, p = 0.031).ConclusionBeing operated when more staff is on vacation significantly affects severe morbidity rate. Future healthcare system policies should prevent the relative shortage of resources during these periods.
Highlights
Institutional experience, team cohesion and personal skills are crucial to achieving excellence in surgery
The heterogeneity of surgical procedures and the lack of standardization on outcome metrics [13] has prevented the drawing of more precise inferences in this field
Major pancreatic resections are complex but highly standardized procedures with specific outcome metrics [13] that are usually centralized in large, high-volume academic centers
Summary
Institutional experience, team cohesion and personal skills are crucial to achieving excellence in surgery. Excellence means better outcomes, such as those obtained through the centralization of high-risk surgical procedures at high-volume hospitals [1] These facilities have a broader range of specialists and technology-based services, different types of intensive care units, more resources and highly standardized clinical pathways that can provide the complex perioperative care needed for patients undergoing major surgical procedures. Despite such a high level of standardization of care, a seasonal variability in outcomes is a common experience even. Major pancreatic resections are complex but highly standardized procedures with specific outcome metrics [13] that are usually centralized in large, high-volume academic centers These features make pancreatic surgery an ideal model for exploring the seasonal variability in surgical outcomes. Future healthcare system policies should prevent the relative shortage of resources during these periods
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