Approach to postpancreatectomy care Impacts outcomes: Retrospective Validation of the PORSCH trial - 26/09/24

Doi : 10.1016/j.amjsurg.2024.05.006

Grace C. Bloomfield, MS ^a, Pejman Radkani, MD ^b, Aradhya Nigam, MD ^c, Jean Namgoong, BS ^a, Jiling Chou, MA ^d, Byoung Uk Park, MD ^e, Thomas M. Fishbein, MD ^b, Emily R. Winslow, MD ^f,^⁎
^a Georgetown University School of Medicine, Washington, DC, USA
^b Department of Transplant Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
^c Department of Surgery, Medstar Georgetown University Hospital, Washington, DC, USA
^d MedStar Health Research Institute Department of Biostatistics & Biomedical Informatics, Hyattsville, MD, USA
^e Department of Laboratory Medicine and Pathology, Mayo Clinic, Rochester, MN, USA
^f University of Wisconsin School of Medicine and Public Health, Madison, WI, USA

^⁎Corresponding author. University of Wisconsin School of Medicine and Public Health, 750 Highland Ave Madison, WI, 53726, USA.University of Wisconsin School of Medicine and Public Health750 Highland Ave MadisonWI53726USA

Abstract

Background

In the recent PORSCH trial, a three-part postpancreatectomy care algorithm was employed with a near 50 % reduction in mortality. We hypothesized that clinical care congruent with this protocol would correlate with better outcomes in our patients.

Methods

Real-world postoperative care was compared to the pathway described by the PORSCH trial and patients were assigned into groups based on congruence with its recommendations. The primary composite outcome (PCO) consisted of 90-day mortality, organ failure, and interventions for bleeding.

Results

Of 289 patients, care of 12 % was entirely congruent with the PORSCH algorithm. The PCO was recorded in 9 % of the PORSCH care group, 8 % of the Partial-PORSCH care group, and 19 % of the Non-PORSCH care group (p = 0.044). Adverse outcomes were highest when pancreaticoduodenectomy patients received care incongruent with the algorithm's CT imaging recommendations.

Conclusions

These results add external validity to the principles of clinical care underlying the PORSCH algorithm.

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Graphical abstract

Image 1

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Highlights

•	Derangements in labwork and vital signs after pancreatectomy warrant investigation.
•	Early detection and treatment of postpancreatectomy complications improves outcomes.
•	The PORSCH trial's algorithm may reduce morbidity and mortality in clinical practice.

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Keywords : Pancreatectomy, Pancreaticoduodenectomy, Postoperative care, PORSCH trial