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Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries
Royal Free Hosp, England; UCL, England.
Cedars Sinai Med Ctr, CA 90048 USA.
King Faisal Specialist Hosp & Res Ctr, Saudi Arabia.
Univ Hosp Southampton, England.
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2024 (English)In: British Journal of Surgery, ISSN 0007-1323, E-ISSN 1365-2168, Vol. 111, no 1, article id znad330Article in journal (Refereed) Published
Abstract [en]

Background: Pancreatic surgery remains associated with high morbidity rates. Although postoperative mortality appears to have improved with specialization, the outcomes reported in the literature reflect the activity of highly specialized centres. The aim of this study was to evaluate the outcomes following pancreatic surgery worldwide. Methods: This was an international, prospective, multicentre, cross-sectional snapshot study of consecutive patients undergoing pancreatic operations worldwide in a 3-month interval in 2021. The primary outcome was postoperative mortality within 90 days of surgery. Multivariable logistic regression was used to explore relationships with Human Development Index (HDI) and other parameters. Results: A total of 4223 patients from 67 countries were analysed. A complication of any severity was detected in 68.7 percent of patients (2901 of 4223). Major complication rates (Clavien-Dindo grade at least IIIa) were 24, 18, and 27 percent, and mortality rates were 10, 5, and 5 per cent in low-to-middle-, high-, and very high-HDI countries respectively. The 90-day postoperative mortality rate was 5.4 per cent (229 of 4223) overall, but was significantly higher in the low-to-middle-HDI group (adjusted OR 2.88, 95 per cent c.i. 1.80 to 4.48). The overall failure-to-rescue rate was 21 percent; however, it was 41 per cent in low-to-middle-compared with 19 per cent in very high-HDI countries. Conclusion: Excess mortality in low-to-middle-HDI countries could be attributable to failure to rescue of patients from severe complications. The authors call for a collaborative response from international and regional associations of pancreatic surgeons to address management related to death from postoperative complications to tackle the global disparities in the outcomes of pancreatic surgery (NCT04652271; ISRCTN95140761).
Place, publisher, year, edition, pages
OXFORD UNIV PRESS , 2024. Vol. 111, no 1, article id znad330
National Category
Surgery
Identifiers
URN: urn:nbn:se:liu:diva-200699DOI: 10.1093/bjs/znad330ISI: 001099633000001OAI: oai:DiVA.org:liu-200699DiVA, id: diva2:1840396
Note

Funding Agencies|Fiorina Royal Free Charity, London, UK; Swiss Pancreas Foundation, Berne, Switzerland

Available from: 2024-02-23 Created: 2024-02-23 Last updated: 2024-10-22Bibliographically approved

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Sandström, Per A

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Faculty of Medicine and Health SciencesDepartment of Surgery in LinköpingDivision of Surgery, Orthopedics and Oncology
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