Root-cause analysis of mortality after pancreatic resection in a nationwide cohort

Anne Claire Henry; F. Jasmijn Smits; Lois A. Daamen; Olivier R. Busch; Koop Bosscha; Ronald M. van Dam; Coen J.L. van Dam; Casper H. van Eijck; Sebastiaan Festen; Erwin van der Harst; Ignace H.J.T. de Hingh; Geert Kazemier; Mike S. Liem; Vincent E. de Meijer; Peter Noordzij; Gijs A. Patijn; Jennifer M.J. Schreinemakers; Martijn W.J. Stommel; Bert A. Bonsing; Bas G. Koerkamp; Marc G. Besselink; Robert C. Verdonk; Hjalmar C. van Santvoort; I. Quintus Molenaar

doi:10.1016/j.hpb.2024.11.014

Root-cause analysis of mortality after pancreatic resection in a nationwide cohort

Anne Claire Henry^*, F. Jasmijn Smits, Lois A. Daamen, Olivier R. Busch, Koop Bosscha, Ronald M. van Dam, Coen J.L. van Dam, Casper H. van Eijck, Sebastiaan Festen, Erwin van der Harst, Ignace H.J.T. de Hingh, Geert Kazemier, Mike S. Liem, Vincent E. de Meijer, Peter Noordzij, Gijs A. Patijn, Jennifer M.J. Schreinemakers, Martijn W.J. Stommel, Bert A. Bonsing, Bas G. KoerkampMarc G. Besselink, Robert C. Verdonk, Hjalmar C. van Santvoort, I. Quintus Molenaar^*,

^*Corresponding author for this work

Research output: Contribution to journal › Article › Academic › peer-review

Abstract

Background: This study evaluates leading causes of in-hospital mortality after pancreatic resection nationwide to determine areas for improvement. Methods: This observational cohort study included all in-hospital mortality after pancreatic resection in the Netherlands (2014–2019). Each fatality was considered to be caused by local complications (i.e. directly related to surgery, located in surgical area) or systemic complications (e.g. cardiac or pulmonary). A blinded Expert Committee reviewed the postoperative course leading to death and identified potential quality improvement measures. Results: Out of 5345 patients undergoing pancreatic resection, 149 patients (2.8 %) died in-hospital. Local complications caused death in 126 patients (85 %) and systemic complications in 23 patients (15 %). Concerning local complications, the common leading causes of death were postoperative pancreatic fistula (n = 41) and thrombosis of vascular reconstructions (n = 23). Systemic cardiac (n = 8) and pulmonary (n = 7) complications caused death frequently. Potential areas for improvement were failure to rescue (n = 89; 60 %), prevention of complications (n = 34, 23 %) and patient selection (n = 14; 9 %). Conclusion: Local complications often caused death after pancreatic resection, mainly pancreatic fistula and vascular reconstruction failure. Failure to rescue was considered the most important area for improvement to decrease in-hospital mortality further.

Original language	English
Pages (from-to)	461-469
Number of pages	9
Journal	HPB
Volume	27
Issue number	4
Early online date	1 Dec 2024
DOIs	https://doi.org/10.1016/j.hpb.2024.11.014
Publication status	Published - Apr 2025

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Henry, A. C., Smits, F. J., Daamen, L. A., Busch, O. R., Bosscha, K., van Dam, R. M., van Dam, C. J. L., van Eijck, C. H., Festen, S., van der Harst, E., de Hingh, I. H. J. T., Kazemier, G., Liem, M. S., de Meijer, V. E., Noordzij, P., Patijn, G. A., Schreinemakers, J. M. J., Stommel, M. W. J., Bonsing, B. A. (2025). Root-cause analysis of mortality after pancreatic resection in a nationwide cohort. HPB, 27(4), 461-469. https://doi.org/10.1016/j.hpb.2024.11.014

@article{bffcedd99e574fe2b1ff1434dafc8404,

title = "Root-cause analysis of mortality after pancreatic resection in a nationwide cohort",

abstract = "Background: This study evaluates leading causes of in-hospital mortality after pancreatic resection nationwide to determine areas for improvement. Methods: This observational cohort study included all in-hospital mortality after pancreatic resection in the Netherlands (2014–2019). Each fatality was considered to be caused by local complications (i.e. directly related to surgery, located in surgical area) or systemic complications (e.g. cardiac or pulmonary). A blinded Expert Committee reviewed the postoperative course leading to death and identified potential quality improvement measures. Results: Out of 5345 patients undergoing pancreatic resection, 149 patients (2.8 %) died in-hospital. Local complications caused death in 126 patients (85 %) and systemic complications in 23 patients (15 %). Concerning local complications, the common leading causes of death were postoperative pancreatic fistula (n = 41) and thrombosis of vascular reconstructions (n = 23). Systemic cardiac (n = 8) and pulmonary (n = 7) complications caused death frequently. Potential areas for improvement were failure to rescue (n = 89; 60 %), prevention of complications (n = 34, 23 %) and patient selection (n = 14; 9 %). Conclusion: Local complications often caused death after pancreatic resection, mainly pancreatic fistula and vascular reconstruction failure. Failure to rescue was considered the most important area for improvement to decrease in-hospital mortality further.",

author = "Henry, {Anne Claire} and Smits, {F. Jasmijn} and Daamen, {Lois A.} and Busch, {Olivier R.} and Koop Bosscha and {van Dam}, {Ronald M.} and {van Dam}, {Coen J.L.} and {van Eijck}, {Casper H.} and Sebastiaan Festen and {van der Harst}, Erwin and {de Hingh}, {Ignace H.J.T.} and Geert Kazemier and Liem, {Mike S.} and {de Meijer}, {Vincent E.} and Peter Noordzij and Patijn, {Gijs A.} and Schreinemakers, {Jennifer M.J.} and Stommel, {Martijn W.J.} and Bonsing, {Bert A.} and Koerkamp, {Bas G.} and Besselink, {Marc G.} and Verdonk, {Robert C.} and {van Santvoort}, {Hjalmar C.} and Molenaar, {I. Quintus}",

note = "Publisher Copyright: {\textcopyright} 2024 The Author(s)",

year = "2025",

month = apr,

doi = "10.1016/j.hpb.2024.11.014",

language = "English",

volume = "27",

pages = "461--469",

number = "4",

}

Henry, AC, Smits, FJ, Daamen, LA, Busch, OR, Bosscha, K, van Dam, RM, van Dam, CJL, van Eijck, CH, Festen, S, van der Harst, E, de Hingh, IHJT, Kazemier, G, Liem, MS, de Meijer, VE, Noordzij, P, Patijn, GA, Schreinemakers, JMJ, Stommel, MWJ, Bonsing, BA, Koerkamp, BG, Besselink, MG, Verdonk, RC, van Santvoort, HC , Molenaar, IQ 2025, 'Root-cause analysis of mortality after pancreatic resection in a nationwide cohort', HPB, vol. 27, no. 4, pp. 461-469. https://doi.org/10.1016/j.hpb.2024.11.014

TY - JOUR

T1 - Root-cause analysis of mortality after pancreatic resection in a nationwide cohort

AU - Henry, Anne Claire

AU - Smits, F. Jasmijn

AU - Daamen, Lois A.

AU - Busch, Olivier R.

AU - Bosscha, Koop

AU - van Dam, Ronald M.

AU - van Dam, Coen J.L.

AU - van Eijck, Casper H.

AU - Festen, Sebastiaan

AU - van der Harst, Erwin

AU - de Hingh, Ignace H.J.T.

AU - Kazemier, Geert

AU - Liem, Mike S.

AU - de Meijer, Vincent E.

AU - Noordzij, Peter

AU - Patijn, Gijs A.

AU - Schreinemakers, Jennifer M.J.

AU - Stommel, Martijn W.J.

AU - Bonsing, Bert A.

AU - Koerkamp, Bas G.

AU - Besselink, Marc G.

AU - Verdonk, Robert C.

AU - van Santvoort, Hjalmar C.

AU - Molenaar, I. Quintus

PY - 2025/4

Y1 - 2025/4

N2 - Background: This study evaluates leading causes of in-hospital mortality after pancreatic resection nationwide to determine areas for improvement. Methods: This observational cohort study included all in-hospital mortality after pancreatic resection in the Netherlands (2014–2019). Each fatality was considered to be caused by local complications (i.e. directly related to surgery, located in surgical area) or systemic complications (e.g. cardiac or pulmonary). A blinded Expert Committee reviewed the postoperative course leading to death and identified potential quality improvement measures. Results: Out of 5345 patients undergoing pancreatic resection, 149 patients (2.8 %) died in-hospital. Local complications caused death in 126 patients (85 %) and systemic complications in 23 patients (15 %). Concerning local complications, the common leading causes of death were postoperative pancreatic fistula (n = 41) and thrombosis of vascular reconstructions (n = 23). Systemic cardiac (n = 8) and pulmonary (n = 7) complications caused death frequently. Potential areas for improvement were failure to rescue (n = 89; 60 %), prevention of complications (n = 34, 23 %) and patient selection (n = 14; 9 %). Conclusion: Local complications often caused death after pancreatic resection, mainly pancreatic fistula and vascular reconstruction failure. Failure to rescue was considered the most important area for improvement to decrease in-hospital mortality further.

AB - Background: This study evaluates leading causes of in-hospital mortality after pancreatic resection nationwide to determine areas for improvement. Methods: This observational cohort study included all in-hospital mortality after pancreatic resection in the Netherlands (2014–2019). Each fatality was considered to be caused by local complications (i.e. directly related to surgery, located in surgical area) or systemic complications (e.g. cardiac or pulmonary). A blinded Expert Committee reviewed the postoperative course leading to death and identified potential quality improvement measures. Results: Out of 5345 patients undergoing pancreatic resection, 149 patients (2.8 %) died in-hospital. Local complications caused death in 126 patients (85 %) and systemic complications in 23 patients (15 %). Concerning local complications, the common leading causes of death were postoperative pancreatic fistula (n = 41) and thrombosis of vascular reconstructions (n = 23). Systemic cardiac (n = 8) and pulmonary (n = 7) complications caused death frequently. Potential areas for improvement were failure to rescue (n = 89; 60 %), prevention of complications (n = 34, 23 %) and patient selection (n = 14; 9 %). Conclusion: Local complications often caused death after pancreatic resection, mainly pancreatic fistula and vascular reconstruction failure. Failure to rescue was considered the most important area for improvement to decrease in-hospital mortality further.

UR - http://www.scopus.com/inward/record.url?scp=85215552058&partnerID=8YFLogxK

U2 - 10.1016/j.hpb.2024.11.014

DO - 10.1016/j.hpb.2024.11.014

M3 - Article

AN - SCOPUS:85215552058

SN - 1365-182X

VL - 27

SP - 461

EP - 469

JO - HPB

JF - HPB

IS - 4

ER -

Root-cause analysis of mortality after pancreatic resection in a nationwide cohort

Abstract

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