• César Beugniez, Alain Sauvanet, Laurent Sulpice, Sébastien Gaujoux, Olivier Turrini, Stéphanie Truant, Lilian Schwarz, Guillaume Piessen, Jean Marc Regimbeau, Fabrice Muscari, Mustapha Adham, François Pattou, Lucil Schneider, Guillaume Clement, Jean-Robert Delpero, François-René Pruvot, Mehdi El Amrani, and French-ACHBT Working Group.
• Department of Digestive Surgery and Transplantation, Claude Huriez University Hospital, Lille, France.
• Ann. Surg. 2021 Nov 1; 274 (5): 789-796.

ObjectivesAnalyze a multicenter cohort of deceased patients after pancreatectomy in high-volume centers in France by performing a root-cause analysis (RCA) to define the avoidable mortality rate.BackgroundDespite undeniable progress in pancreatic surgery for over a century, postoperative outcome remains particularly worse and could be further improved.MethodsAll patients undergoing pancreatectomy between January 2015 and December 2018 and died postoperatively within 90 days after were included. RCA was performed in 2 stages: the first being the exhaustive collection of data concerning each patient from preoperative to death and the second being blind analysis of files by an independent expert committee. A typical root cause of death was defined with the identification of avoidable death.ResultsAmong the 3195 patients operated on in 9 participating centers, 140 (4.4%) died within 90 days after surgery. After the exclusion of 39 patients, 101 patients were analyzed. The cause of death was identified in 90% of cases. After RCA, mortality was preventable in 30% of cases, mostly consequently to a preoperative assessment (disease evaluation) or a deficient postoperative management (notably pancreatic fistula and hemorrhage). An inappropriate intraoperative decision was incriminated in 10% of cases. The comparative analysis showed that young age and arterial resection, especially unplanned, were often associated with avoidable mortality.ConclusionsOne-third of postoperative mortality after pancreatectomy seems to be avoidable, even if the surgery is performed in high volume centers. These data suggest that improving postoperative pancreatectomy outcome requires a multidisciplinary, rigorous, and personalized management.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

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