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

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.