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HPB Surgery
Volume 2015 (2015), Article ID 896875, 14 pages
http://dx.doi.org/10.1155/2015/896875
Review Article

Feasibility of Comparing the Results of Pancreatic Resections between Surgeons: A Systematic Review and Meta-Analysis of Pancreatic Resections

1Department of Surgery, UCL Medical School, Royal Free Campus, London NW3 2PF, UK
2Public Health Research Unit, West Sussex County Council, County Hall Campus, West Sussex PO19 1QT, UK
3Evidence Synthesis, Sightsavers, 35 Perrymount Road, Haywards Heath, West Sussex RH16 3BW, UK
4Department of Applied Health Research, UCL, London WC1E 7HB, UK

Received 13 May 2015; Accepted 15 July 2015

Academic Editor: Attila Olah

Copyright © 2015 Kurinchi Gurusamy et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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.