American Surgical Association Annual Meeting
Search Meeting Site Only
 
Main ASA Website
Current Meeting Home
Final Program
Past & Future Meetings

 

 

Back to 2016 Annual Meeting


Grading of Surgeon Technical Performance Predicts Post-Operative Pancreatic Fistula for the Pancreaticoduodenectomy Independent of Patient Related Variables
Melissa E Hogg*1, Mazen Zenati*1, Stephanie Novak*1, Yong Chen*2, Yan Jun*3, Jennifer Steve*1, Stacy Kowalsky*1, David L Bartlett1, Amer Zureikat*1, Herbert Zeh, III1
1UPMC, Pittsburgh, PA;2The first affiated hospital, Chongqing Medical University, Chongqing, China3Shanghai Jiao Tong University Affiliated Sixth People's Hospital, Shanghai, China

Background: Pancreatic fistula (POPF) majorly contributes to pancreaticoduodenectomy morbidity. Braga and Callery scores, derived from patient variables, are validated for predicting POPF. Birkmeyer showed assessment of surgical proficiency is an important component of outcomes. We hypothesized that video grading of surgical performance would contribute to estimating risk of POPF following pancreaticoduodenectomy.
Methods: POPF were diagnosed using ISGPF. Technical performance of robotic pancreaticojejunostomy (Blumgart duct-to-mucosa) video was graded by two blinded surgeons using: 1) subjective prediction of POPF, 2) pancreaticojejunostomy step-by-step variables (PJV; max=115), and 3) scoring used by Birkmeyer (OSATS).
Results: 133 pancreaticojejunostomies were analyzed (139.5 video hours). POPF was 18%. Higher Braga (p=0.041) and Callery (p=0.011) scores predicted POPF. Graders’ subjective prediction did not correlate with Braga/Callery scores. PJV and OSATS scores highly correlated (p<0.0001). Grader 1 scores (p=0.043), but not grader 2 (p=0.44), predicted POPF. PJV scores >105 were predictive of POPF (p=0.039). Scoring only PJV duct-to-mucosa stitches (max=50) was highly predictive of POPF (p=0.0053). Higher OSATS scores were associated with decreased rate of POPF (p=0.022). On multivariate analysis, adding technical scoring to significant patient variables (BMI, texture, and duct size) improves the model and can independently predict POPF. The strongest predictive model for POPF consisted of soft gland (Odds=18.28 [95%=2.19-152.57]) and low OSATS (Odds=0.82 [95%=0.70-0.96]). OSATS, modeled with Braga or Callery scores, independently predicted PF.
Conclusion: This is the first study to demonstrate that technical scoring of a surgeon’s performance independently predicts patient outcomes in pancreatic surgery. Future studies should consider how to incorporate this metric.


Back to 2016 Annual Meeting


© 2022 American Surgical Association. All Rights Reserved. Privacy Policy.