Root-Cause Analysis of Mortality Following Pancreatic Resection (CARE Study): A Multicenter Cohort Study.

Abstract

OBJECTIVES\nAnalyze 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.\n\n\nBACKGROUND\nDespite undeniable progress in pancreatic surgery for over a century, postoperative outcome remain particularly worse and could be further improved.\n\n\nMETHODS\nAll patients undergoing pancreatectomy between January 2015 and December 2018 and died post-operatively within 90\u200adays after were included. RCA was performed in two 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.\n\n\nRESULTS\nAmong the 3195 patients operated on in nine participating centers, 140 (4.4%) died within 90\u200adays 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.\n\n\nCONCLUSION\nOne 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.