• Alessandro Giani, Tess van Ramshorst, Michele Mazzola, Claudio Bassi, Alessandro Esposito, Matteo de Pastena, Bjørn Edwin, Mushegh Sahakyan, Dyre Kleive, Asif Jah, Stijn van Laarhoven, Ugo Boggi, Emanuele Federico Kauffman, Riccardo Casadei, Claudio Ricci, Safi Dokmak, Fadhel Samir Ftériche, Steven A White, Sivesh K Kamarajah, Giovanni Butturini, Isabella Frigerio, Alessandro Zerbi, Giovanni Capretti, Elizabeth Pando, Robert P Sutcliffe, Ravi Marudanayagam, Giuseppe Kito Fusai, Jean Michel Fabre, Bergthor Björnsson, Lea Timmermann, Zahir Soonawalla, Fernando Burdio, Tobias Keck, Thilo Hackert, Bas Groot Koerkamp, Mathieu d'Hondt, Andrea Coratti, Patrick Pessaux, Andrea Pietrabissa, Bilal Al-Sarireh, Marco V Marino, Quintus Molenaar, Vincent Yip, Marc Besselink, Giovanni Ferrari, HilalMohammad AbuMADepartment of General Surgery, Istituto Ospedaliero Fondazione Poliambulanza, Brescia, Italy., and European Consortium on Minimally Invasive Pancreatic Surgery (E-MIPS).
• Division of Minimally Invasive Surgical Oncology, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy.
• Br J Surg. 2022 Oct 14; 109 (11): 1124-1130.

BackgroundBenchmarking is the process to used assess the best achievable results and compare outcomes with that standard. This study aimed to assess best achievable outcomes in minimally invasive distal pancreatectomy with splenectomy (MIDPS).MethodsThis retrospective study included consecutive patients undergoing MIDPS for any indication, between 2003 and 2019, in 31 European centres. Benchmarks of the main clinical outcomes were calculated according to the Achievable Benchmark of Care (ABC™) method. After identifying independent risk factors for severe morbidity and conversion, risk-adjusted ABCs were calculated for each subgroup of patients at risk.ResultsA total of 1595 patients were included. The ABC was 2.5 per cent for conversion and 8.4 per cent for severe morbidity. ABC values were 160 min for duration of operation time, 8.3 per cent for POPF, 1.8 per cent for reoperation, and 0 per cent for mortality. Multivariable analysis showed that conversion was associated with male sex (OR 1.48), BMI exceeding 30 kg/m2 (OR 2.42), multivisceral resection (OR 3.04), and laparoscopy (OR 2.24). Increased risk of severe morbidity was associated with ASA fitness grade above II (OR 1.60), multivisceral resection (OR 1.88), and robotic approach (OR 1.87).ConclusionThe benchmark values obtained using the ABC method represent optimal outcomes from best achievable care, including low complication rates and zero mortality. These benchmarks should be used to set standards to improve patient outcomes.© The Author(s) 2022. Published by Oxford University Press on behalf of BJS Society Ltd. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

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