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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.


Number of complications. The figure shows the forest plot of number of complications. The number of complications per 100 patients ranged between 40 and 132. The average number of complications per 100 patients by random-effects model was 80.
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fig5: Number of complications. The figure shows the forest plot of number of complications. The number of complications per 100 patients ranged between 40 and 132. The average number of complications per 100 patients by random-effects model was 80.

Mentions: The number of complications (as opposed to the proportion of people with complications) was reported in 18 studies including 4763 patients [22, 35, 37, 38, 40, 42, 44–49, 52, 54, 55, 57–59]. The number of complications per 100 patients ranged between 40 and 132 (lower quartile = 61 per 100 patients; upper quartile = 95 per 100 patients). The numbers of complications per 100 patients in individual studies are shown in Figure 5. The average number of complications per 100 patients was 80 (95% CI 70 to 90; I2 = 94.3%). There was no evidence of publication bias by Egger's regression test (P = 0.4189).


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)

Number of complications. The figure shows the forest plot of number of complications. The number of complications per 100 patients ranged between 40 and 132. The average number of complications per 100 patients by random-effects model was 80.
© Copyright Policy - open-access
Related In: Results  -  Collection

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

fig5: Number of complications. The figure shows the forest plot of number of complications. The number of complications per 100 patients ranged between 40 and 132. The average number of complications per 100 patients by random-effects model was 80.
Mentions: The number of complications (as opposed to the proportion of people with complications) was reported in 18 studies including 4763 patients [22, 35, 37, 38, 40, 42, 44–49, 52, 54, 55, 57–59]. The number of complications per 100 patients ranged between 40 and 132 (lower quartile = 61 per 100 patients; upper quartile = 95 per 100 patients). The numbers of complications per 100 patients in individual studies are shown in Figure 5. The average number of complications per 100 patients was 80 (95% CI 70 to 90; I2 = 94.3%). There was no evidence of publication bias by Egger's regression test (P = 0.4189).

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.