K.H. Schwartzman1, M. Sestito1, B. Niemann1, K. Ranson1, C. Espinosa1, C.R. Schmidt1, B. Boone1 1West Virginia University, Department Of Surgery, Morgantown, WEST VIRGINIA, USA
Introduction: Textbook outcome is a group of desired outcomes which are defined as optimal within different subsets of surgery. These data points are then compared to the systems database percentiles for the specific procedure the patient underwent. The parameters of “ideal outcome” following open pancreatoduodenectomy are relatively well established. However, factors that predict textbook outcomes are not well established. The goal of this study is to establish any constituents that may make textbook outcome more likely, as well as to understand any longitudinal outcomes TO might be predictive of.
Methods: Patients who received a robotic pancreaticoduodenectomy at a single academic medical center between May of 2019 and March of 2024 were included in this historical cohort study. Textbook outcome was established using 6 variables: Postoperative Pancreatic fistula or leak within 90 days, bile leak within 90 days, post operative hemorrhage, Clavien Dindo surgical complication score, readmission within 90 days, and in hospital mortality within 90 days. Information was collected from patient charts regarding demographics, chemotherapy and radiation, surgery, recovery, and frailty. These variables were then compared between subjects with textbook and non textbook outcomes.
Results: 145 patients were included in the final data analysis. 79 patients (52.41%) had a textbook outcome. It was found that the mean operative time was significantly higher in the non textbook cohort in comparison to the textbook cohort, indicating that extended operative time may be predictive of outcome (315.78 vs. 349.76, p = 0.00072). The Textbook cohort had significantly lower length of stay (6.052 vs. 11.333, p = 6.69 x 10-8). The overall survival time was significantly longer for the Textbook group (747.25 vs 575.10, p = 0.032). Patients from rural counties were found to be significantly more likely to have a non-textbook outcome as compared to their counterparts from nonrural counties (63.77% vs. 36.23%, p = 0.04). Finally, it was found that patients with textbook outcomes had a further average hometown distance from the surgical center (85.55 miles vs. 68.29 miles, p = 0.045).
Conclusion: Patients with textbook outcomes as defined by these criteria have shorter periods of hospitalizations and longer overall survival time post operatively. Patients with longer operative times are more likely to have outcomes that are not textbook. Interestingly, patients from rural counties are more likely to have a non textbook outcome, however distance from the hospital is positively correlated to textbook outcome. It is well established that patients from rural counties have limited access to medical resources. The findings of this study imply that special care may need to be taken during their period of postoperative hospitalization to address this disadvantage and prevent further complication.