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Feasibility of Comparing the Results of Pancreatic Resections between Surgeons: A Systematic Review and Meta-Analysis of Pancreatic Resections.

Gurusamy K, Toon C, Virendrakumar B, Morris S, Davidson B - HPB Surg (2015)

Bottom Line: Proportions that lay outside the upper 95% and 99.8% confidence intervals based on results of the systematic reviews were considered as "outliers." Results.The surgeon-specific mortality should be 5 times the average mortality before he or she can be identified as an outlier with 0.1% false positive rate if he or she performs 50 surgeries a year.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, UCL Medical School, Royal Free Campus, London NW3 2PF, UK.

ABSTRACT
Background. Indicators of operative outcomes could be used to identify underperforming surgeons for support and training. The feasibility of identifying HPB surgeons with poor operative performance ("outliers") based on the results of pancreatic resections is not known. Methods. A systematic review of Medline, Embase, and the Cochrane library was performed to identify studies on pancreatic resection including at least 100 patients and published between 2004 and 2014. Proportions that lay outside the upper 95% and 99.8% confidence intervals based on results of the systematic reviews were considered as "outliers." Results. In total, 30 studies reporting on 10712 patients were eligible for inclusion in this review. The average short-term mortality after pancreatic resections was 3.1% and proportion of patients with procedure-related complications was 47.0%. None of the classification systems assessed the long-term impact of the complications on patients. The surgeon-specific mortality should be 5 times the average mortality before he or she can be identified as an outlier with 0.1% false positive rate if he or she performs 50 surgeries a year. Conclusions. A valid risk prognostic model and a classification system of surgical complications are necessary before meaningful comparisons of the operative performance between pancreatic surgeons can be made.

No MeSH data available.


Proportion of patients with complications. The figure shows the forest plot of patients with complications. The proportion of people with complications ranged between 3.3% and 100.0%. The average proportion of complications by random-effects model was 47.0%.
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fig4: Proportion of patients with complications. The figure shows the forest plot of patients with complications. The proportion of people with complications ranged between 3.3% and 100.0%. The average proportion of complications by random-effects model was 47.0%.

Mentions: The proportion of people with complications was reported in 23 studies including 6712 patients [20, 21, 23, 35–41, 43, 45–50, 52, 54–57, 60]. The proportion of people with complications ranged between 3.3% and 100.0% (lower quartile = 38.3%; upper quartile = 53.4%). The proportions of people with complications in individual studies are shown in Figure 4. The average proportion of people with complications was 47.0% (95% CI 36.0% to 59.0%; I2 = 98.9%). There was significant publication bias as denoted by Egger's regression test (P = 0.0037) with the funnel plot suggesting that studies with lower complication proportions were more likely to be published.


Feasibility of Comparing the Results of Pancreatic Resections between Surgeons: A Systematic Review and Meta-Analysis of Pancreatic Resections.

Gurusamy K, Toon C, Virendrakumar B, Morris S, Davidson B - HPB Surg (2015)

Proportion of patients with complications. The figure shows the forest plot of patients with complications. The proportion of people with complications ranged between 3.3% and 100.0%. The average proportion of complications by random-effects model was 47.0%.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4553327&req=5

fig4: Proportion of patients with complications. The figure shows the forest plot of patients with complications. The proportion of people with complications ranged between 3.3% and 100.0%. The average proportion of complications by random-effects model was 47.0%.
Mentions: The proportion of people with complications was reported in 23 studies including 6712 patients [20, 21, 23, 35–41, 43, 45–50, 52, 54–57, 60]. The proportion of people with complications ranged between 3.3% and 100.0% (lower quartile = 38.3%; upper quartile = 53.4%). The proportions of people with complications in individual studies are shown in Figure 4. The average proportion of people with complications was 47.0% (95% CI 36.0% to 59.0%; I2 = 98.9%). There was significant publication bias as denoted by Egger's regression test (P = 0.0037) with the funnel plot suggesting that studies with lower complication proportions were more likely to be published.

Bottom Line: Proportions that lay outside the upper 95% and 99.8% confidence intervals based on results of the systematic reviews were considered as "outliers." Results.The surgeon-specific mortality should be 5 times the average mortality before he or she can be identified as an outlier with 0.1% false positive rate if he or she performs 50 surgeries a year.Conclusions.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, UCL Medical School, Royal Free Campus, London NW3 2PF, UK.

ABSTRACT
Background. Indicators of operative outcomes could be used to identify underperforming surgeons for support and training. The feasibility of identifying HPB surgeons with poor operative performance ("outliers") based on the results of pancreatic resections is not known. Methods. A systematic review of Medline, Embase, and the Cochrane library was performed to identify studies on pancreatic resection including at least 100 patients and published between 2004 and 2014. Proportions that lay outside the upper 95% and 99.8% confidence intervals based on results of the systematic reviews were considered as "outliers." Results. In total, 30 studies reporting on 10712 patients were eligible for inclusion in this review. The average short-term mortality after pancreatic resections was 3.1% and proportion of patients with procedure-related complications was 47.0%. None of the classification systems assessed the long-term impact of the complications on patients. The surgeon-specific mortality should be 5 times the average mortality before he or she can be identified as an outlier with 0.1% false positive rate if he or she performs 50 surgeries a year. Conclusions. A valid risk prognostic model and a classification system of surgical complications are necessary before meaningful comparisons of the operative performance between pancreatic surgeons can be made.

No MeSH data available.