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Defining Factors Associated with Textbook Outcomes (TO) in Hepaticopancreaticobiliary Surgery
Abdimajid Mohamed, Timothy Fitzgerald
Surgical Oncology, Tufts University School of Medicine, Portland, Maine, United States

Objective
Textbook outcomes (TO) have recently emerged as a valuable metric to assess postoperative outcomes. This study seeks to delineate factors associated with TO for patients undergoing hepaticopancreaticobiliary surgery.

Design
Retrospective cohort study

Setting
This study utilized NSQIP data from 2015-2018.

Patients
The study included patients undergoing hepaticopancreaticobiliary surgery. Textbook outcomes are defined as no readmission/mortality within 30 days, complication, and length of stay within the 75th percentile.

Results
This study included 44,235 patients. Of those patients, 61% underwent pancreatic surgery (PS) and 39% hepatic surgery (HS). The most commonly performed surgical procedure was pancreaticoduodenectomy (16,464), followed by partial hepatic lobectomy (11,817), distal pancreatectomy (8,292), hepatic lobectomy (4,247), hepatic trisegmentectomy (1,366) and total pancreatectomy (706). TO was more common for HS when compared to PS, 47 vs. 40%, p <0.001. TO was more common for younger (0-65, OR 1.63; CI 1.33-2.00, p < .001), female (OR 1.22; CI 1.17-1.28, p < .001), white (OR 1.11;CI 1.02-1.20, p=0.012), and lower ASA class (OR 1.22;CI 1.17-1.28, p < .001) patients. For patients undergoing HS TO was more common after partial lobectomy compared to trisegmentectomy and lobectomy (OR 1.36; CI 1.19-1.58, p<0.001). For those undergoing PS, there was a lower likelihood for TO for those who are obese/morbidly obese when compared to normal-weight patients (OR 0.72; CI .67-.78, p<0.001).

Conclusions
Textbook outcomes (TO) are a useful metric for patients undergoing pancreatic and hepatic surgery. For patients undergoing HS, more complex surgical procedures are associated with a decreased likelihood of TO. In contrast, for patients undergoing PS, TO are similar regardless of the procedure but less common for patients who are obese or morbidly obese.


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