Pancreatic surgery outcomes: multicentre prospective snapshot study in 67 countries

Giuseppe Kito Fusai,Cristina Ferrone,Dimitri Aristotle Raptis,Mohamed Abu Hilal,Claudio Bassi,Marc Besselink,Kevin Conlon,Brian Davidson,Marco Del Chiaro,Christos Dervenis,Isabella Frigerio,Massimo Falconi,Thilo Hackert,Ewen M. Harrison, Shailesh Shrikhande,Ajith Siriwardena,Martin Smith,Christopher Wolfgang,Aditya Borakati,Deniz Balci,Muhammed Elhadi,Camila Hidalgo Salinas,Nikolaos Machairas,Giovanni Marchegiani,Atsushi Oba,Christian Oberkofler,Ioannis Passas, Reena Ravikumar, Patricia Sanchez Velazquez,Martin de Santibanes,Andreas Anton Schnitzbauer,Fiammetta Soggiu,Domenico Tamburrino,Pascale Tinguely,Alice Wei, Marinos Zachiotis, Kamel Bentabak, Salah Eddine Kacimi,Mehrdad Nikfarjam, Aliaksei Shcherba,Gregory Sergeant, Gustavo Coelho, Orlando Torres,Nikolay Belev, Burundi Fabrice,Ephraim Tang,Janet Martin, Christian Diaz,Nicolas Devaud, Kongyuan Wei,Maher Hendi, Danko Mikulic,Nikolaos Gouvas, Thalis Christophides, Andrej Nikov, Dalia Fathallah, Mahmoud Saad, Olav Tammik,Heikki Huhta,Laurent Sulpice,Renato Lupinacci,Zaza Demetrashvili,Gregor A. Stavrou,Evangelos Felekouras, Vasileios Papaziogas, Sanjeev Misra, Erik Prabowo Diponegoro, Hashim Talib Hashim, Maytham Al-Juaifari Al-Sader,Sohei Satoi,Khaled Obeidat, Maram Mohsen,Ildar Fakhradiyev,Ho-Seong Han,Mohamad Khalife,Audrius Dulskas, Jin Bong,Shahi Ghani, Alejandro Eduardo Padilla, Javier Melchor-Ruan,Sarnai Erdene, Amine Benkabbou, Pueya Nashidengo,Jonathan Koea, Ademola Adeyeye,Olusegun Alatise, Sami Ullah, Mustafa Abu Jayyab, Sarah Amro, Walaa Mohammed Alnammourah, Catherine The,Michal Pedziwiatr,Wojciech Polkowski,Sorin Traian Barbu,Aleksandar Karamarkovic, Daniel Galun,Brian K. P. Goh,Blaz Trotovsek,Jones Omoshoro-Jones,Benedetto Ielpo, Abdelfatah Abdelmageed, Per Sandstrom, Alessandra Cristaudi, Beat Gloor, Christoph Kuemmerli, Alaa Hamdan Tishreen, Mohammad Karam Chaaban, Chien Hui Wu, Po-Chih Yang Fu Jen, Ammar Houssem, Oussama Baraket, Ahmet Coker, Mark Taylor, Nigel Jamieson, Satheesh Iype, Emmanouil Giorgakis, Motaz Qadan, Sabha Ganai, Hamza Al-Naggar, Onesai Chihaka

BRITISH JOURNAL OF SURGERY(2023)

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摘要
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).
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