Can trainees safely perform pancreatoenteric anastomosis? A systematic review, meta-analysis, and risk-adjusted analysis of postoperative pancreatic fistula.
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Ошибки и ограничения
История · было → стало
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PARANOIA Study Group. Electronic address: https://www.twitter.com/paranoia_group, Writing Committee, Pande Rupaly, Halle-Smith James M, Thorne Thomas, Hiddema Lydia, Hodson James, Roberts Keith J, Steering Committee, Arshad Ali, Connor Saxon, Conlon Kevin C P, Dickson Euan J, Giovinazzo Francesco, Harrison Ewen, de Liguori Carino Nicola, Hore Todd, Knight Stephen R, Loveday Benjamin, Magill Laura, Mirza Darius, Pandanaboyana Sanjay, Perry Rita J, Pinkney Thomas, Siriwardena Ajith K, Satoi Sohei, Skipworth James, Stättner Stefan, Sutcliffe Robert P, Tingstedt Bobby
Аннотация
METHODS: A systematic review of the literature was performed using Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, with differences in postoperative pancreatic fistula rates after pancreatoenteric anastomosis between trainee-led versus consultant/attending surgeons pooled using meta-analysis. Variation in rates of postoperative pancreatic fistula was further explored using risk-adjusted outcomes using published risk scores and cumulative sum control chart analysis in a retrospective cohort.
RESULTS: Across 14 cohorts included in the meta-analysis, trainees tended toward a lower but nonsignificant rate of all postoperative pancreatic fistula (odds ratio: 0.77, P = .45) and clinically relevant postoperative pancreatic fistula (odds ratio: 0.69, P = .37). However, there was evidence of case selection, with trainees being less likely to operate on patients with a pancreatic duct width <3 mm (odds ratio: 0.45, P = .05). Similarly, analysis of a retrospective cohort (N = 756 cases) found patients operated by trainees to have significantly lower predicted all postoperative pancreatic fistula (median: 20 vs 26%, P < .001) and clinically relevant postoperative pancreatic fistula (7 vs 9%, P = .020) rates than consultant/attending surgeons, based on preoperative risk scores. After adjusting for this on multivariable analysis, the risks of all postoperative pancreatic fistula (odds ratio: 1.18, P = .604) and clinically relevant postoperative pancreatic fistula (odds ratio: 0.85, P = .693) remained similar after pancreatoenteric anastomosis by trainees or consultant/attending surgeons.
CONCLUSION: Pancreatoenteric anastomosis, when performed by trainees, is associated with acceptable outcomes. There is evidence of case selection among patients undergoing surgery by trainees; hence, risk adjustment provides a critical tool for the objective evaluation of performance.