3 years ago

Sensitizing Surgeons to Their Outcome Has No Measurable Short-term Benefit

Sensitizing Surgeons to Their Outcome Has No Measurable Short-term Benefit
Laurent, Christophe, Grégoire, Emilie, Vibert, Eric, Soubrane, Olivier, Regimbeau, Jean Marc, Pruvot, Francois René, Farges, Olivier, Delpero, Jean Robert, Scatton, Olivier, Boleslawski, Emmanuel, Cauchy, Francois, Bachellier, Philippe, Adham, Mustapha, Mabrut, Jean Yves
Objective: Investigate if involving surgeons in outcome prediction-research and having them use a dedicated Electronic-Health-Record that provides feedback, improves patients’ outcome. Background: Improvement of clinical outcome mainly relies on the declaration of adverse events, identification of their predictors, self-assessment, and feedback. Methods: Thirteen French Hepato-Pancreato-Biliary-centers made commitment to include all patients undergoing elective hepatectomies in an observational study. Each center was given access to a dedicated website, where perioperative data were prospectively collected. The website provided real-time individual and comparative feedback of outcome and was also intended to perform prognostication studies. The hypothesis was that by using this strategy, the length-of-stay would be reduced by 10%. Power-calculation implied the inclusion of 1720 patients. Secondary endpoints were 90-day mortality, severe morbidity, and the comprehensive-complication index. Results: Only 5 of the 13 participating centers were fully compliant in enrolling their patients and the inclusion period was extended by 1-year (October 2012–October 2015) to meet the objective. During this period, the collaborative group published 9 studies based on the study data (median impact factor = 8.327) that identified quantitative clinical variables, qualitative clinical variables, and nonclinical variables influencing outcome. For patients enrolled by the 5 active centers (n = 1752), there was no improvement in length of stay (13.3 vs 12.4 days, P = 0.287), severe complications (23.6 vs 20.5%, P = 0.134), the complication comprehensive index (24.0 vs 24.9, P = 0.448), mortality (4.1 vs 3.9%, P = 0.903), or unplanned readmissions (7.2 vs 8.4%, P = 0.665), even after adjusting for confounders. Conclusion: Simply sensitizing surgeons to their outcome has no measurable short-term clinical benefit.
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