Two open whipples a day: Excessive or efficient.

Abstract

BACKGROUND:

Demand for pancreatic surgery is rising, occasionally necessitating consecutive PDs to be performed by a single surgeon in the same workday. The safety of this practice is unknown.

METHODS:

Institutional prospective ACS-NSQIP data were reviewed for PDs (2013-2017). Instances where a single surgeon performed two PDs in the same day were a PD pair (PD1, PD2) and compared with univariable analysis. Paired vs. unpaired-PD matched analyses were performed.

RESULTS:

661 PDs (25-PD pairs) were performed. PD1 and PD2 revealed similar infectious (12% vs16%), pulmonary (8% vs8%), cardiovascular (12% vs4%), and aggregate (24% vs24%) morbidity (P>0.05). Pancreatic fistula (B + C 0%), delayed gastric emptying (4% vs12%), hospital stay (9.3 vs8.8 days), and 30-day mortality (4% vs4%) were similar (P > 0.05). Matched outcomes were similar except higher cardiovascular morbidity for paired vs. unpaired PD (7% vs0%; P = 0.015).

CONCLUSION:

With proper patient selection, and in experienced hands at high-volume centers, two consecutive open PDs may be safely performed.

• Authors: Rachel E Simpson, Mitchell L Fennerty, Katelyn F Flick, Cameron L Colgate, Eugene P Ceppa, Michael G House, Nicholas J Zyromski, Attila Nakeeb, C Max Schmidt
• Journal: American journal of surgery (Am J Surg) Vol. 219 Issue 3 Pg. 390-393 (03 2020) ISSN: 1879-1883 [Electronic] United States
• PMID: 31761301 (Publication Type: Journal Article)
• Copyright: Copyright © 2019 Elsevier Inc. All rights reserved.

Topics

• Aged
• Clinical Competence
• Efficiency
• Fatigue
• Female
• Humans
• Male
• Middle Aged
• Operative Time
• Pancreaticoduodenectomy
• Patient Safety
• Patient Selection
• Postoperative Complications (epidemiology)
• Quality of Health Care
• Retrospective Studies
• Workload