TABLE 3.
Outcomes in Learning Phases
| Before proficiency cutoff ≤62 RPD (N=410) [n (%)] | After proficiency cutoff >62 RPD (N=225) [n (%)] | P | Before mastery cutoff ≤84 RPD (N=480) [n (%)] | After mastery cutoff >84 RPD (N=155) [n (%)] | P | |
|---|---|---|---|---|---|---|
| Safety outcomes | ||||||
| Conversion | 32 (7.8) | 10 (4.4) | 0.069 | 33 (6.9) | 9 (6.2) | 0.400 |
| Clavien-Dindo complication ≥III | 145 (35.4) | 89 (39.6) | 0.295 | 173 (36.0) | 61 (39.4) | 0.543 |
| Requiring catheter drainage | 126 (30.7) | 84 (37.3) | 0.091 | 169 (33.1) | 41 (32.8) | 0.517 |
| Reoperation | 50 (12.2) | 11 (4.9) | 0.004 | 53 (11.0) | 8 (5.2) | 0.018 |
| Unplanned intensive care unit admission | 55 (13.4) | 16 (7.1) | 0.010 | 56 (11.7) | 15 (9.7) | 0.494 |
| Textbook outcome | 288 (70.2) | 146 (64.9) | 0.165 | 334 (69.6) | 100 (64.5) | 0.238 |
| Type I34 only (no additional resection) | 250/346 (72.3) | 145/216 (67.1) | 0.053 | 293/410 (71.5) | 92/145 (62.8) | 0.072 |
| Other outcomes | ||||||
| Length of initial stay [median (IQR)] (d) | 11 (7–18) | 11 (7–19) | 0.654 | 11 (7–19) | 11 (7–21) | 0.488 |
| Initial hospital stay <7 d | 66 (16.1) | 33 (14.7) | 0.371 | 79 (16.5) | 19 (12.3) | 0.270 |
| Readmission | 95 (23.1) | 50 (22.2) | 0.823 | 104 (21.7) | 41 (26.4) | 0.216 |
| In-hospital/30-d mortality | 14 (3.4) | 8 (3.5) | 0.629 | 15 (3.1) | 7 (4.5) | 0.410 |
| POPF (B/C) | 95 (23.2) | 76 (33.8) | 0.004 | 131 (24.2) | 40 (35.5) | <0.001 |
| Of which grade C | 10 (2.4) | 1 (0.4) | 11 (2.3) | 0 (0.0) | ||
| Grade B/C in class A and B (soft) | 61/250 (24.4) | 57/156 (36.5) | 0.006 | 75/296 (25.3) | 43/110 (39.1) | 0.007 |
| Grade B/C in class C and D (hard) | 13/71 (18.3) | 7/22 (31.8) | 0.178 | 17/78 (21.8) | 3/15 (20.0) | 0.591 |
| Bile leakage (B/C) | 31 (7.6) | 20 (8.9) | 0.308 | 39 (8.1) | 12 (7.7) | 0.517 |
| Delayed gastric emptying (B/C) | 113 (27.6) | 36 (16.0) | 0.001 | 124 (25.8) | 25 (16.1) | 0.008 |
| Postpancreatectomy hemorrhage (B/C) | 53 (13.0) | 24 (10.6) | 0.228 | 56 (11.7) | 21 (13.5) | 0.400 |
| Chyle leakage (B/C) | 9 (2.2) | 8 (3.6) | 0.540 | 11 (2.3) | 6 (3.9) | 0.752 |
| Wound infection* | 36 (8.8) | 4 (1.8) | <0.001 | 39 (8.1) | 1 (0.6) | <0.001 |
| Oncologic outcome | ||||||
| Tumor size [median (IQR)] (mm) | 25 (18–33) | 25 (15–35) | 0.584 | 25 (18–35) | 25 (15–35) | 0.654 |
| Lymph node harvest† [n (IQR)] | 15 (12–19) | 14 (11–17) | 0.024 | 15 (12–19) | 14 (10–17) | 0.013 |
| R0 resection† | 216/294 (73.5) | 97/132 (73.4) | 0.377 | 253/345 (73.3) | 60/81 (74.1) | 0.813 |
| R0 resection in PDAC | 60/110 (54.5) | 31/48 (64.6) | 0.132 | 69/127 (54.3) | 22/31 (71.0) | 0.230 |
*
Wound infection (surgical site infection) required at least opening, flushing and covering of the wound with gauze.
†
In patients with malignant disease.