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• W4313143735 abstract "Introduction: Early recognition and management of postoperative complications, before they become clinically manifest, may improve outcomes of surgical patients, especially in high-risk procedures such as pancreatic resection. Method: We conducted a nationwide stepped-wedge cluster randomized trial. All patients undergoing pancreatic resection over a 22-month period in The Netherlands were included. 17 centers were randomized for time to crossover from usual care (control group) to treatment according to a multimodal, multidisciplinary algorithm for early recognition and minimally invasive management of postoperative complications (intervention group). The algorithm included daily evaluation of clinical and biochemical markers. It determined when to perform abdominal computed tomography, radiologic drainage, start antibiotic treatment and remove abdominal drains. The primary end-point was a composite of bleeding requiring invasive intervention, organ failure, and 90-day mortality. Results: 1748 patients were included. The primary end-point occurred in 73 of 863 patients (8.5%) in the intervention group and in 124 of 885 patients (14.0%) in the control group (odds ratio 0.42, 95% confidence interval [CI] 0.27 to 0.66, P<0.001). There was a decrease in organ failure (4.5% vs. 10.3%, odds ratio 0.30, 95%CI 0.18 to 0.50, P<0.001) and a lower 90-day mortality (2.7% vs. 5.0%, odds ratio 0.38, 95%CI 0.18 to 0.82, P=0.01) in patients treated according to the algorithm. Conclusions: The algorithm for early recognition and minimally invasive management of complications after pancreatic resection reduced the composite end-point of bleeding requiring invasive intervention, organ failure and death, as compared to usual care. This included an approximate 50% reduction of nationwide mortality." @default.
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• W4313143735 date "2022-01-01" @default.
• W4313143735 modified "2023-09-27" @default.
• W4313143735 title "Early Recognition and Management of Complications after Pancreatic Surgery" @default.
• W4313143735 doi "https://doi.org/10.1016/j.hpb.2022.05.128" @default.
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