• J Annelie Suurmeijer, Anne Claire Henry, Bert A Bonsing, Koop Bosscha, Ronald M van Dam, Casper H van Eijck, Michael F Gerhards, Erwin van der Harst, Ignace H de Hingh, Martijn P Intven, Geert Kazemier, Johanna W Wilmink, Daan J Lips, Fennie Wit, Vincent E de Meijer, I Quintus Molenaar, Gijs A Patijn, George P van der Schelling, StommelMartijn W JMWJDepartment of Surgery, Radboud University Medical Center Nijmegen, the Netherlands., Olivier R Busch, Bas Groot Koerkamp, Hjalmar C van Santvoort, Marc G Besselink, and Dutch Pancreatic Cancer Group.
• Amsterdam UMC, Department of Surgery, University of Amsterdam, Amsterdam, the Netherlands.
• Ann. Surg. 2023 Aug 1; 278 (2): 260266260-266.

ObjectiveTo describe outcome after pancreatic surgery in the first 6 years of a mandatory nationwide audit.BackgroundWithin the Dutch Pancreatic Cancer Group, efforts have been made to improve outcome after pancreatic surgery. These include collaborative projects, clinical auditing, and implementation of an algorithm for early recognition and management of postoperative complications. However, nationwide changes in outcome over time have not yet been described.MethodsThis nationwide cohort study included consecutive patients after pancreatoduodenectomy (PD) and distal pancreatectomy from the mandatory Dutch Pancreatic Cancer Audit (January 2014-December 2019). Patient, tumor, and treatment characteristics were compared between 3 time periods (2014-2015, 2016-2017, and 2018-2019). Short-term surgical outcome was investigated using multilevel multivariable logistic regression analyses. Primary endpoints were failure to rescue (FTR) and in-hospital mortality.ResultsOverall, 5345 patients were included, of whom 4227 after PD and 1118 after distal pancreatectomy. After PD, FTR improved from 13% to 7.4% [odds ratio (OR) 0.64, 95% confidence interval (CI) 0.50-0.80, P <0.001] and in-hospital mortality decreased from 4.1% to 2.4% (OR 0.68, 95% CI 0.54-0.86, P =0.001), despite operating on more patients with age >75 years (18%-22%, P =0.006), American Society of Anesthesiologists score ≥3 (19%-31%, P <0.001) and Charlson comorbidity score ≥2 (24%-34%, P <0.001). The rates of textbook outcome (57%-55%, P =0.283) and major complications remained stable (31%-33%, P =0.207), whereas complication-related intensive care admission decreased (13%-9%, P =0.002). After distal pancreatectomy, improvements in FTR from 8.8% to 5.9% (OR 0.65, 95% CI 0.30-1.37, P =0.253) and in-hospital mortality from 1.6% to 1.3% (OR 0.88, 95% CI 0.45-1.72, P =0.711) were not statistically significant.ConclusionsDuring the first 6 years of a nationwide audit, in-hospital mortality and FTR after PD improved despite operating on more high-risk patients. Several collaborative efforts may have contributed to these improvements.Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.

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