Prospective study on predictability of complications by pancreatic surgeons

Purpose We evaluated the intuition of expert pancreatic surgeons, in predicting the associated risk of pancreatic resection and compared this “intuition” to actual operative follow-up. The objective was to avoid major complications following pancreatic resection, which remains a challenge. Methods F...

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Bibliographic Details
Published in:Langenbeck's archives of surgery 2020-03, Vol.405 (2), p.155-163
Main Authors: Vanbrugghe, Charles, Birnbaum, David Jérémie, Boucekine, Mohamed, Ewald, Jacques, Marchese, Ugo, Guilbaud, Théophile, Berdah, Stéphane Victor, Moutardier, Vincent
Format: Article
Language:English
Subjects:
Abdominal Surgery
Adult
Aged
Aged, 80 and over
Cardiac Surgery
Clinical Competence
Female
General Surgery
Humans
Intuition
Male
Medicine
Medicine & Public Health
Middle Aged
Original Article
Pancreatectomy - adverse effects
Pancreatic Neoplasms - complications
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
Pancreaticoduodenectomy - adverse effects
Postoperative Complications - diagnosis
Postoperative Complications - epidemiology
Predictive Value of Tests
Prospective Studies
Risk Assessment
Risk Factors
Thoracic Surgery
Traumatic Surgery
Vascular Surgery
Young Adult
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Summary:Purpose We evaluated the intuition of expert pancreatic surgeons, in predicting the associated risk of pancreatic resection and compared this “intuition” to actual operative follow-up. The objective was to avoid major complications following pancreatic resection, which remains a challenge. Methods From January 2015 to February 2018, all patients who were 18 years old or more undergoing a pancreatic resection (pancreaticoduodenectomy [PD], distal pancreatectomy [DP], or central pancreatectomy [CP]) for pancreatic lesions were included. Preoperatively and postoperatively, all surgeons completed a form assessing the expected potential occurrence of clinically relevant postoperative pancreatic fistula (CR-POPF: grade B or C), postoperative hemorrhage, and length of stay. Results Preoperative intuition was assessed for 101 patients for 52 PD, 44 DP, and 5 CP cases. Overall mortality and morbidity rates were 6.9% ( n  = 7) and 67.3% ( n  = 68), respectively, and 38 patients (37.6%) developed a POPF, including 27 (26.7%) CR-POPF. Concordance between preoperative intuition of CR-POPF occurrence and reality was minimal, with a Cohen’s kappa coefficient ( κ ) of 0.175 ( P value = 0.009), and the same result was obtained between postoperative intuition and reality ( κ  = 0.351; P  
ISSN:1435-2443
1435-2451
DOI:10.1007/s00423-020-01866-3