Seasonal variations in pancreatic surgery outcome A retrospective time-trend analysis of 2748 Whipple procedures
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ORIGINAL ARTICLE
Seasonal variations in pancreatic surgery outcome A retrospective time‑trend analysis of 2748 Whipple procedures Giovanni Marchegiani1 · Stefano Andrianello1 · Chiara Nessi1 · Tommaso Giuliani1 · Giuseppe Malleo1 · Salvatore Paiella1 · Roberto Salvia1 · Claudio Bassi1 Received: 29 May 2020 / Accepted: 9 August 2020 © The Author(s) 2020
Abstract Background Observing cyclic patterns in surgical outcome is a common experience. We aimed to measure this phenomenon and to hypothesize possible causes using the experience of a high-volume pancreatic surgery department. Methods Outcomes of 2748 patients who underwent a Whipple procedure at a single high-volume center from January 2000 to December 2018 were retrospectively analyzed. Three different hypotheses were tested: the effect of climate changes, the “July effect” and the effect of vacations. Results Clavien-Dindo ≥ 3 morbidity was similar during warm vs. cold months (22.5% vs. 19.8%, p = 0.104) and at the beginning of activity of new trainees vs. the rest of the year (23.5 vs. 22.5%, p = 0.757). Patients operated when a high percentage of staff is on vacation showed an increased Clavien-Dindo ≥ 3 morbidity (22.3 vs. 18.5%, p = 0.022), but similar mortality (2.3 vs. 1.8%, p = 0.553). The surgical waiting list was also significantly longer during these periods (37 vs. 27 days, p = 0.037). Being operated in such a period of the year was an independent predictor of severe morbidity (OR 1.271, CI 95% 1.086–1.638, p = 0.031). Conclusion Being operated when more staff is on vacation significantly affects severe morbidity rate. Future healthcare system policies should prevent the relative shortage of resources during these periods. Keywords Seasonal variations · Outcomes · Surgery · Pancreas · July effect
Introduction Institutional experience, team cohesion and personal skills are crucial to achieving excellence in surgery. Excellence means better outcomes, such as those obtained through the centralization of high-risk surgical procedures at high-volume hospitals [1]. These facilities have a broader range of specialists and technology-based services, different types of intensive care units, more resources and highly standardized clinical pathways that can provide the complex perioperative care needed for patients undergoing major surgical procedures. Despite such a high level of standardization of care, a seasonal variability in outcomes is a common experience even * Claudio Bassi [email protected] 1
Department of General and Pancreatic Surgery, The Pancreas Institute, University of Verona Hospital Trust, P.le Scuro 10, 37134 Verona, Italy
if an evidence-based approach has led to variable results [2–8]. Seasonal climate changes have been identified as the possible cause of worse surgical outcomes during the summer months, especially for surgical site infections [9]. Other studies have reported an increased morbidity rate in July and August at the beginning of the academic year, when new trainees and residents provide patient care for the fir
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