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©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2024; 16(3): 681-688
Published online Mar 27, 2024. doi: 10.4240/wjgs.v16.i3.681
Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center: Value of tailored peri-pancreatectomy protocols
Shamir O Cawich, Elijah Dixon, Parul J Shukla, Shailesh V Shrikhande, Rahul R Deshpande, Fawwaz Mohammed, Neil W Pearce, Wesley Francis, Shaneeta Johnson, Johann Bujhawan
Shamir O Cawich, Fawwaz Mohammed, Department of Surgery, University of the West Indies, St Augustine 000000, Trinidad and Tobago
Elijah Dixon, Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Alberta T2N2T9, Canada
Parul J Shukla, Department of Surgery, Weill Cornell Medical College, New York, NY 10065, United States
Shailesh V Shrikhande, Department of Surgical Oncology, Tata Memorial Center, Homi Bhabha National University, Mumbai 400012, India
Rahul R Deshpande, Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
Neil W Pearce, University Surgical Unit, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
Wesley Francis, Department of Surgery, University of the West Indies, Nassau N-1184, Bahamas
Shaneeta Johnson, Department of Surgery, Morehouse School of Medicine, Atlanta, GA 30310, United States
Johann Bujhawan, Department of Surgery, General Hospital in Port of Spain, Port of Spain 000000, Trinidad and Tobago
Author contributions: Cawich SO, Dixon E, Sukla PJ, and Shrikhande SV designed the research; Cawich SO, Mohammed F, Pearce NW, and Francis W performed the research; Deshpande R, Pearce NW, Johnson S, and Bujhawan J contributed data analytic tools; Cawich SO, Mohammed F, Deshpane R, Pearce NW, and Johnson S analyzed the data; Cawich SO, Dixon E, Sukla PJ, and Shrikhande SV wrote the paper; Cawich SO, Dixon E, Sukla PJ, Shrikhande SV, Deshpande R, Mohammed F, Pearce NW, Francis W, Johnson S, and Bujhawan J checked the manuscript for scientific accuracy.
Institutional review board statement: This study was approved by the Campus Research Ethics Committee, St. Augustine.
Informed consent statement: This was a retrospective review of written hospital records, the requirement for informed consent was waived by the local institutional review board.
Conflict-of-interest statement: The authors have no conflicts of interest to declare.
Data sharing statement: All data are stored by the corresponding author and will be released upon reasonable request.
STROBE statement: The authors have read the STROBE Statement—checklist of items, and the manuscript was prepared and revised according to the STROBE Statement—checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See:
https://creativecommons.org/Licenses/by-nc/4.0/ Corresponding author: Shamir O Cawich, FACS, Professor, Department of Surgery, University of the West Indies, St. Augustine Campus, St Augustine 000000, Trinidad and Tobago. socawich@hotmail.com
Received: December 6, 2023
Peer-review started: December 6, 2023
First decision: December 28, 2023
Revised: January 3, 2024
Accepted: January 27, 2024
Article in press: January 27, 2024
Published online: March 27, 2024
ARTICLE HIGHLIGHTS
Research background
Peri-operative outcomes differ between institutions due to a variety of factors. This can affect the way individual hospitals manage complications, and also their mortality rates after pancreaticoduodenectomies (PDs).
Research motivation
Our facility in the Caribbean is a low-volume center with numerous challenges. Tailored peri-pancreatic protocols were devised specifically to compensate for challenges at our facility. These have not been evaluated prior to this study.
Research objectives
The ability to rescue patients from post-PD complications is as a recognized quality measure. This study sought to document the rate of rescue from post-PD complications with tailored protocols in place as a measure of quality.
Research methods
A 10-year retrospective audit was performed to evaluate rescue rates in patients who experienced major post-PD complications. Standardized definitions from the International Study Group of Pancreatic Surgery were used to define post-PD complications and the modified Clavien-Dindo classification was used to classify post-PD complications. All data were examined with SPSS version 18.0.
Research results
There were 113 patients who underwent PDs and 33 experienced major morbidity. Twenty-nine (87.9%) patients were salvaged after aggressive treatment of their complication. There was a significantly greater salvage rate in patients with American Society of Anesthesiologists scores ≤ 2 (93.3% vs 25%; P = 0.0024).
Research conclusions
Despite low volumes and multiple hospital challenges, we were able to achieve acceptable rescue rates after post-PD complications. We attributed this to several factors including development tailored peri-pancreatectomy protocols.
Research perspectives
This adds to existing data that volume alone should not be used as a quality measure. It encourages further research with larger numbers since this early research shows encouraging results.
