Benchmarking Performance in Pancreatic Surgery: a Systematic Review of Published Quality Metrics
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REVIEW ARTICLE
Benchmarking Performance in Pancreatic Surgery: a Systematic Review of Published Quality Metrics Cindy Ou 1 & Michaela Rektorysova 1 & Bushra Othman 2 & John A. Windsor 1,3 & Sanjay Pandanaboyana 4 & Benjamin P. T. Loveday 1,2,5 Received: 29 June 2020 / Accepted: 8 October 2020 # 2020 The Society for Surgery of the Alimentary Tract
Abstract Background Pancreatic surgery is performed in relatively few centres. There are validated quality benchmarks for pancreatic surgery, although it remains unclear how published benchmarks compare with each other. This study aimed to systematically review published literature to summarise metrics that define quality benchmarks for pancreatic surgery. Method A search of MEDLINE, EMBASE and CENTRAL was undertaken until June 2019. Articles that developed or validated published quality benchmarks for pancreatic surgery were included. Benchmarks were classified into three domains using the Donabedian framework, and their quality assessed using the AIRE Instrument. Results Nineteen studies included 55 quality metrics, of which 8 developed new metrics, and 11 studies validated previously published metrics. The methodology of metric development was either expert opinion-driven or data-driven. All metrics demonstrated moderate quality scores. There was partial agreement in some metrics (e.g. < 10 h total operative duration), but lack of consensus for most others (e.g. lymph node yield ≥ 10, ≥ 12, ≥ 15, ≥ 16). No metrics related to patient reported outcomes. Conclusions Published quality benchmarks for pancreatic surgery predominantly arise from eight studies, with heterogeneity in how the metrics were developed. There was not consensus for all metrics. Metrics need to be reviewed as new data emerge, technologies develop and opinions change. Keywords Pancreas . Surgical procedures, operative . Benchmarking . Systematic review
Supplementary Information The online version of this article (https:// doi.org/10.1007/s11605-020-04827-9) contains supplementary material, which is available to authorized users. Cindy Ou and Michaela Rektorysova are joint first authors. Statement: This research is not based on previous communication to a society or meeting. * Benjamin P. T. Loveday [email protected] 1
Department of Surgery, University of Auckland, Auckland, New Zealand
2
Department of Surgical Oncology, Peter MacCallum Cancer Centre, Melbourne, Australia
3
Department of Surgery, Auckland District Health Board, Auckland, New Zealand
4
HPB and Transplant Unit, Freeman Hospital, Newcastle, Upon Tyne, UK
5
Department of Surgery, Royal Melbourne Hospital, Melbourne, Australia
Background Pancreatic surgery is highly specialised performed in relatively few centres. Internationally, there has been a movement to centralise complex procedures, like pancreatic surgery, into high volume centres.1 The rationale for this is a potential volume-outcome relationship, with high volume pancreatic centres demonstrating superior outcomes.2 The reasons for this relationship are complex, a
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