Nationwide prospective audit of pancreatic surgery: design, accuracy, and outcomes of the Dutch Pancreatic Cancer Audit

L Bengt van Rijssen; Bas G Koerkamp; Maurice J Zwart; Bert A Bonsing; Koop Bosscha; Ronald M van Dam; Casper H van Eijck; Michael F Gerhards; Erwin van der Harst; Ignace H de Hingh; Koert P de Jong; Geert Kazemier; Joost Klaase; Cornelis J van Laarhoven; I Quintus Molenaar; Gijs A Patijn; Coen G Rupert; Hjalmar C van Santvoort; Joris J Scheepers; George P van der Schelling; Olivier R Busch; Marc G Besselink; Dutch Pancreatic Cancer Group

doi:10.1016/j.hpb.2017.06.010

Nationwide prospective audit of pancreatic surgery: design, accuracy, and outcomes of the Dutch Pancreatic Cancer Audit

HPB (Oxford). 2017 Oct;19(10):919-926. doi: 10.1016/j.hpb.2017.06.010. Epub 2017 Jul 26.

Authors

L Bengt van Rijssen¹, Bas G Koerkamp², Maurice J Zwart¹, Bert A Bonsing³, Koop Bosscha⁴, Ronald M van Dam⁵, Casper H van Eijck², Michael F Gerhards⁶, Erwin van der Harst⁷, Ignace H de Hingh⁸, Koert P de Jong⁹, Geert Kazemier¹⁰, Joost Klaase¹¹, Cornelis J van Laarhoven¹², I Quintus Molenaar¹³, Gijs A Patijn¹⁴, Coen G Rupert¹⁵, Hjalmar C van Santvoort¹⁶, Joris J Scheepers¹⁷, George P van der Schelling¹⁸, Olivier R Busch¹, Marc G Besselink¹⁹; Dutch Pancreatic Cancer Group

Collaborators

Dutch Pancreatic Cancer Group:
Thomas L Bollen²⁰, Marco J Bruno²¹, Geert-Jan van Tienhoven²², Arnold Norduyn²³, David P Berry²⁴, Bobby Tingstedt²⁵, Jennifer F Tseng²⁶, Christopher L Wolfgang²⁷

Affiliations

¹ Department of Surgery, Academic Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands.
² Department of Surgery, Erasmus Medical Center, Rotterdam, The Netherlands.
³ Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands.
⁴ Department of Surgery, Jeroen Bosch Hospital, 's Hertogenbosch, The Netherlands.
⁵ Department of Surgery, Maastricht University Medical Center, Maastricht, The Netherlands.
⁶ Department of Surgery, Onze Lieve Vrouwe Gasthuis, Amsterdam, The Netherlands.
⁷ Department of Surgery, Maasstad Hospital, Rotterdam, The Netherlands.
⁸ Department of Surgery, Catharina Hospital, Eindhoven, The Netherlands.
⁹ Department of Surgery, University Medical Center Groningen, Groningen, The Netherlands.
¹⁰ Department of Surgery, VU University Medical Center, Amsterdam, The Netherlands.
¹¹ Department of Surgery, Medisch Spectrum Twente, Enschede, The Netherlands.
¹² Department of Surgery, Radboud University Medical Center, The Netherlands.
¹³ Department of Surgery, University Medical Center Utrecht, Utrecht, The Netherlands.
¹⁴ Department of Surgery, Isala Clinics, Zwolle, The Netherlands.
¹⁵ Department of Surgery, Tjongerschans Hospital, Heerenveen, The Netherlands.
¹⁶ Department of Surgery, St Antonius Hospital, Nieuwegein, The Netherlands.
¹⁷ Department of Surgery, Reinier de Graaf Gasthuis, Delft, The Netherlands.
¹⁸ Department of Surgery, Amphia Hospital, Breda, The Netherlands.
¹⁹ Department of Surgery, Academic Medical Center, Cancer Center Amsterdam, Amsterdam, The Netherlands. Electronic address: m.g.besselink@amc.nl.
²⁰ Department of Radiology, St. Antonius Hospital, Nieuwegein, The Netherlands.
²¹ Department of Gastroenterology, Erasmus Medical Center, Rotterdam, The Netherlands.
²² Department of Radiotherapy, Academic Medical Center, Amsterdam, The Netherlands.
²³ Dordrecht, The Netherlands.
²⁴ Leicester General Hospital, Leicester, UK.
²⁵ Skåne University Hospital, Lund, Sweden.
²⁶ Beth Israel Deaconess Medical Center, Boston, MA, USA.
²⁷ The Johns Hopkins School of Medicine, Baltimore, MD, USA.

PMID: 28754367
DOI: 10.1016/j.hpb.2017.06.010

Abstract

Background: Auditing is an important tool to identify practice variation and 'best practices'. The Dutch Pancreatic Cancer Audit is mandatory in all 18 Dutch centers for pancreatic surgery.

Methods: Performance indicators and case-mix factors were identified by a PubMed search for randomized controlled trials (RCT's) and large series in pancreatic surgery. In addition, data dictionaries of two national audits, three institutional databases, and the Dutch national cancer registry were evaluated. Morbidity, mortality, and length of stay were analyzed of all pancreatic resections registered during the first two audit years. Case ascertainment was cross-checked with the Dutch healthcare inspectorate and key-variables validated in all centers.

Results: Sixteen RCT's and three large series were found. Sixteen indicators and 20 case-mix factors were included in the audit. During 2014-2015, 1785 pancreatic resections were registered including 1345 pancreatoduodenectomies. Overall in-hospital mortality was 3.6%. Following pancreatoduodenectomy, mortality was 4.1%, Clavien-Dindo grade ≥ III morbidity was 29.9%, median (IQR) length of stay 12 (9-18) days, and readmission rate 16.0%. In total 97.2% of >40,000 variables validated were consistent with the medical charts.

Conclusions: The Dutch Pancreatic Cancer Audit, with high quality data, reports good outcomes of pancreatic surgery on a national level.

MeSH terms

Aged
Databases, Factual
Female
Hospital Mortality
Humans
Length of Stay
Male
Medical Audit
Middle Aged
Netherlands
Pancreatectomy* / adverse effects
Pancreatectomy* / mortality
Pancreatectomy* / standards
Pancreaticoduodenectomy* / adverse effects
Pancreaticoduodenectomy* / mortality
Pancreaticoduodenectomy* / standards
Patient Readmission
Postoperative Complications / etiology
Postoperative Complications / mortality
Process Assessment, Health Care* / standards
Prospective Studies
Quality Indicators, Health Care* / standards
Registries
Research Design
Risk Factors
Time Factors
Treatment Outcome