TITLE:
Operative Time as a Measure of Quality in Pancreaticoduodenectomy: Is Faster Better? A Retrospective Review Using the ACS NSQIP Database
AUTHORS:
Gwendolyn M. Garnett, Lynne Wilkens, Whitney Limm, Linda L. Wong
KEYWORDS:
Pancreaticoduodenectomy, Operative Time
JOURNAL NAME:
Surgical Science,
Vol.6 No.9,
September
28,
2015
ABSTRACT: Objective: To determine if pancreaticoduodenectomy operative time can
provide insight into surgeon performance and thus be considered for use as a
quality indicator. Background: Case volume is the traditional quality metric
for complex pancreatic surgery, with studies showing better outcomes for
high-volume providers. However, there are surgeons performing fewer cases with
good quality who are overlooked for referrals directed to high-volume “centers
of excellence”. Additional quality metrics are needed. Methods: The ACS NSQIP
database (2005-2011) was used to identify 4805 pancreaticoduodenectomy patients.
Cases were divided at the mean operative time (ORtime) into those ≤373 (n = 2638,
54.9%) vs ≥373 minutes in duration. Complications and outcome measures were
compared and predictors of 30-day mortality were assessed. Results: Age ≤ 65
years, male sex, prior chemotherapy, prior radiation, disseminated cancer,
diabetes, recent MI, no prior TIA, lower bilirubin and platelet count, and
higher prothrombin time were associated with ORtime > 373 minutes. Patients
with ORtime > 373 minutes demonstrated more intra-abdominal and superficial
infections, wound dehiscence, bleeding requiring transfusion, need for
reintubation, septic shock, and returns to OR. ORtime > 373 minutes was
associated with longer hospital stay and increased 30-day mortality. ORtime
> 373 minutes was a significant and independent predictor in a stepwise
model of 30-day mortality. Conclusions: Shorter pancreaticoduodenectomy
operative time is associated with fewer complications, shorter hospital stays
and lower 30-day mortality after adjusting for patient factors. This may imply
that shorter operative time is associated with superior surgical outcome. Operative
time may provide insight into surgeon performance and be considered for use as
a quality metric.