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Root-cause Analysis of Mortality After Pancreatic Resection (CARE Study) A Multicenter Cohort Study

Abstract : Objectives: Analyze a multicenter cohort of deceased patients after pancreatectomy in high-volume centers in France by performing a root-cause analysis (RCA) to define the avoidable mortality rate. Background: Despite undeniable progress in pancreatic surgery for over a century, postoperative outcome remains particularly worse and could be further improved. Methods: All patients undergoing pancreatectomy between January 2015 and December 2018 and died postoperatively within 90 days after were included. RCA was performed in 2 stages: the first being the exhaustive collection of data concerning each patient from preoperative to death and the second being blind analysis of files by an independent expert committee. A typical root cause of death was defined with the identification of avoidable death. Results: Among the 3195 patients operated on in 9 participating centers, 140 (4.4%) died within 90 days after surgery. After the exclusion of 39 patients, 101 patients were analyzed. The cause of death was identified in 90% of cases. After RCA, mortality was preventable in 30% of cases, mostly consequently to a preoperative assessment (disease evaluation) or a deficient postoperative management (notably pancreatic fistula and hemorrhage). An inappropriate intraoperative decision was incriminated in 10% of cases. The comparative analysis showed that young age and arterial resection, especially unplanned, were often associated with avoidable mortality. Conclusions: One-third of postoperative mortality after pancreatectomy seems to be avoidable, even if the surgery is performed in high volume centers. These data suggest that improving postoperative pancreatectomy outcome requires a multidisciplinary, rigorous, and personalized management.
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https://hal-u-picardie.archives-ouvertes.fr/hal-03595509
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Soumis le : jeudi 3 mars 2022 - 11:10:07
Dernière modification le : jeudi 1 septembre 2022 - 12:52:44

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Cesar Beugniez, Alain Sauvanet, Laurent Sulpice, Sebastien Gaujoux, Olivier Turrini, et al.. Root-cause Analysis of Mortality After Pancreatic Resection (CARE Study) A Multicenter Cohort Study. Annals of Surgery, Lippincott, Williams & Wilkins, 2021, 274 (5), pp.789-796. ⟨10.1097/SLA.0000000000005118⟩. ⟨hal-03595509⟩

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