The Rate of Avoidable Pancreatic Resections at a High-Volume Center: An Internal Quality Control and Critical Review
Background: The incidence of benign diseases among pancreatic resections for suspected malignancy still represents a relevant issue in the surgical practice. This study aims to identify the preoperative pitfalls that led to unnecessary surgeries at a single Austrian center over a twenty-year period....
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-02-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/12/4/1625 |
| _version_ | 1797620159274287104 |
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| author | Niccolò Surci Christiane Sophie Rösch Patrick Kirchweger Lukas Havranek Paul von Boetticher Ines Fischer Helwig Valentin Wundsam Matthias Biebl Reinhold Függer |
| author_facet | Niccolò Surci Christiane Sophie Rösch Patrick Kirchweger Lukas Havranek Paul von Boetticher Ines Fischer Helwig Valentin Wundsam Matthias Biebl Reinhold Függer |
| author_sort | Niccolò Surci |
| collection | DOAJ |
| description | Background: The incidence of benign diseases among pancreatic resections for suspected malignancy still represents a relevant issue in the surgical practice. This study aims to identify the preoperative pitfalls that led to unnecessary surgeries at a single Austrian center over a twenty-year period. Methods: Patients undergoing surgery for suspected pancreatic/periampullary malignancy between 2000 and 2019 at the Linz Elisabethinen Hospital were included. The rate of “mismatches” between clinical suspicion and histology was considered as primary outcome. All cases that, despite that, fulfilled the indication criteria for surgery were defined as minor mismatches (MIN-M). Conversely, the true avoidable surgeries were identified as major mismatches (MAJ-M). Results: Among the 320 included patients, 13 (4%) presented with benign lesions at definitive pathology. The rate of MAJ-M was 2.8% (<i>n</i> = 9), and the most frequent causes of misdiagnoses were autoimmune pancreatitis (<i>n</i> = 4) and intrapancreatic accessory spleen (<i>n</i> = 2). In all MAJ-M cases, various mistakes within the preoperative workup were detected: lack of multidisciplinary discussion (<i>n</i> = 7, 77.8%); inappropriate imaging (<i>n</i> = 4, 44.4%); lack of specific blood markers (<i>n</i> = 7, 77.8%). The morbidity and mortality rates for mismatches were 46.7% and 0. Conclusion: All avoidable surgeries were the result of an incomplete pre-operative workup. The adequate identification of the underlying pitfalls could lead to minimize and, potentially, overcome this phenomenon with a concrete optimization of the surgical-care process. |
| first_indexed | 2024-03-11T08:38:07Z |
| format | Article |
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| institution | Directory Open Access Journal |
| issn | 2077-0383 |
| language | English |
| last_indexed | 2024-03-11T08:38:07Z |
| publishDate | 2023-02-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-db2eec268d8a46f2bd82a03a41a4c2b82023-11-16T21:22:12ZengMDPI AGJournal of Clinical Medicine2077-03832023-02-01124162510.3390/jcm12041625The Rate of Avoidable Pancreatic Resections at a High-Volume Center: An Internal Quality Control and Critical ReviewNiccolò Surci0Christiane Sophie Rösch1Patrick Kirchweger2Lukas Havranek3Paul von Boetticher4Ines Fischer5Helwig Valentin Wundsam6Matthias Biebl7Reinhold Függer8Department of Surgery, Ordensklinikum Linz GmbH, Elisabethinen Hospital, 4020 Linz, AustriaDepartment of Surgery, Ordensklinikum Linz GmbH, Elisabethinen Hospital, 4020 Linz, AustriaDepartment of Surgery, Ordensklinikum Linz GmbH, Elisabethinen Hospital, 4020 Linz, AustriaDepartment of Surgery, Ordensklinikum Linz GmbH, Elisabethinen Hospital, 4020 Linz, AustriaDepartment of Surgery, Ordensklinikum Linz GmbH, Elisabethinen Hospital, 4020 Linz, AustriaDepartment of Surgery, Ordensklinikum Linz GmbH, Elisabethinen Hospital, 4020 Linz, AustriaDepartment of Surgery, Ordensklinikum Linz GmbH, Elisabethinen Hospital, 4020 Linz, AustriaDepartment of Surgery, Ordensklinikum Linz GmbH, Elisabethinen Hospital, 4020 Linz, AustriaDepartment of Surgery, Ordensklinikum Linz GmbH, Elisabethinen Hospital, 4020 Linz, AustriaBackground: The incidence of benign diseases among pancreatic resections for suspected malignancy still represents a relevant issue in the surgical practice. This study aims to identify the preoperative pitfalls that led to unnecessary surgeries at a single Austrian center over a twenty-year period. Methods: Patients undergoing surgery for suspected pancreatic/periampullary malignancy between 2000 and 2019 at the Linz Elisabethinen Hospital were included. The rate of “mismatches” between clinical suspicion and histology was considered as primary outcome. All cases that, despite that, fulfilled the indication criteria for surgery were defined as minor mismatches (MIN-M). Conversely, the true avoidable surgeries were identified as major mismatches (MAJ-M). Results: Among the 320 included patients, 13 (4%) presented with benign lesions at definitive pathology. The rate of MAJ-M was 2.8% (<i>n</i> = 9), and the most frequent causes of misdiagnoses were autoimmune pancreatitis (<i>n</i> = 4) and intrapancreatic accessory spleen (<i>n</i> = 2). In all MAJ-M cases, various mistakes within the preoperative workup were detected: lack of multidisciplinary discussion (<i>n</i> = 7, 77.8%); inappropriate imaging (<i>n</i> = 4, 44.4%); lack of specific blood markers (<i>n</i> = 7, 77.8%). The morbidity and mortality rates for mismatches were 46.7% and 0. Conclusion: All avoidable surgeries were the result of an incomplete pre-operative workup. The adequate identification of the underlying pitfalls could lead to minimize and, potentially, overcome this phenomenon with a concrete optimization of the surgical-care process.https://www.mdpi.com/2077-0383/12/4/1625pancreaticsurgerypreoperative workupclinical managementquality of care |
| spellingShingle | Niccolò Surci Christiane Sophie Rösch Patrick Kirchweger Lukas Havranek Paul von Boetticher Ines Fischer Helwig Valentin Wundsam Matthias Biebl Reinhold Függer The Rate of Avoidable Pancreatic Resections at a High-Volume Center: An Internal Quality Control and Critical Review Journal of Clinical Medicine pancreaticsurgery preoperative workup clinical management quality of care |
| title | The Rate of Avoidable Pancreatic Resections at a High-Volume Center: An Internal Quality Control and Critical Review |
| title_full | The Rate of Avoidable Pancreatic Resections at a High-Volume Center: An Internal Quality Control and Critical Review |
| title_fullStr | The Rate of Avoidable Pancreatic Resections at a High-Volume Center: An Internal Quality Control and Critical Review |
| title_full_unstemmed | The Rate of Avoidable Pancreatic Resections at a High-Volume Center: An Internal Quality Control and Critical Review |
| title_short | The Rate of Avoidable Pancreatic Resections at a High-Volume Center: An Internal Quality Control and Critical Review |
| title_sort | rate of avoidable pancreatic resections at a high volume center an internal quality control and critical review |
| topic | pancreaticsurgery preoperative workup clinical management quality of care |
| url | https://www.mdpi.com/2077-0383/12/4/1625 |
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