Benchmarking Pancreaticoduodenectomy Outcomes in Peru: a 15-year Single-Institution Experience Using Global Quality Metrics.

BACKGROUND

Reporting standards for pancreaticoduodenectomy (PD) in low- and middle-income countries remain uneven, and regional data continues to be scarce. In this study, we summarize 15 years of experience from a high-volume center in Peru using internationally recognized surgical quality metrics.

METHODS

We reviewed 414 PDs performed between 2009 and 2023. Outcomes were examined across three 5-year periods, using established definitions for morbidity, mortality, and key pancreatic complications. Composite indicators-Failure to Rescue (FTR) and Ideal Outcome (IO)-were also applied.

RESULTS

Overall morbidity was 54.1 %; major morbidity was 30.7 %, and in-hospital mortality was 4.8 %. Ninety-day mortality was 6.0 %, FTR 15.7 %, and IO 60.1 %, all without significant temporal changes. Clinically relevant POPF occurred at 22 %, decreasing early on and rising again during the pandemic period. Delayed gastric emptying occurred at 10.4 %, while PPH (8.5 %), readmission (5.8 %), reoperation (10.6 %), and length of stay (11 days) remained stable. Periampullary adenocarcinoma accounted for most indications (78 %), with ampullary tumors being the most frequent.

CONCLUSIONS

This series-the largest contemporary Latin American report applying IO and FTR-shows outcomes comparable to international reference centers. These results were sustained despite increasing case complexity, the introduction of minimally invasive PD, and the disruptions caused by the COVID-19 pandemic.