Achieving an optimal textbook outcome following pancreatic resection: The impact of surgeon specific experience in achieving high quality outcomes

The interplay of patient-, procedural, and provider-level factors on the ability to achieve a textbook outcome(TO) remain poorly defined.The Medicare Standard Analytical Files from 2013 to 2017 were used to identify beneficiaries who underwent pancreatic surgery. Multivariable logistic regression with mixed effects was used to examine the role of the individual surgeon relative to patient- and procedural-factors to achieve a TO.Among 20,902 patients who underwent pancreatic resection, median age was 72 years (IQR:68-77); roughly one-half of the cohort was female(47,4%) and the majority was White (89.3%). After controlling for patient- and procedure-related characteristics, there was 35% variation in odds of experiencing a TO relative to the specific individual surgeon who performed the operation (OR:1.35, 95%CI:1.29-1.41). Patients who underwent pancreatectomy by a bottom TO quartile surgeon had a higher observed/expected ratio for each component of TO including post-operative complication (OR:2.62, 95%CI:2.11-3.25), prolonged LOS (OR:3.36, 95%CI:2.67-4.22), 90-day readmission (OR:2.08, 95%CI:1.68-2.56), and 90-day mortality (OR:3.29, 95% CI:2.35-4.63) compared with patients treated by a high TO quartile surgeon.The likelihood of achieving a TO after pancreatic resection was markedly influenced by the individual treating surgeon even after controlling for patient- and procedure-level factors.