Comparing perioperative processes of care in high and low mortality centers performing pancreatic surgery.

BACKGROUND: Pancreatic surgery outcomes vary widely. We hypothesize that by comparing high and low mortality hospitals, we may identify differences in patient care impacting safety. METHODS: We sampled hospitals with very-low and very-high mortality (LMH; HMH) and conducted on-site chart reviews evaluating perioperative care practices for pancreatic operations. RESULTS: HMHs had an 11.6% mortality rate; LMHs 1.5%. Patients in HMHs had worse ASA classification (20.9% ASA Class 4/5 vs. 2.0%, P < 0.001) and comorbidity burden (55.3% with ≥ 1 comorbidity vs. 39.6%, P = 0.037). At HMHs, operations took longer (353.9 min vs. 313.7 min, P = 0.05), had higher blood loss (1,203.7 ml vs. 881.6 ml, P = 0.04), and patients underwent more transfusions (70.2% vs. 41.1%, P < 0.001). There were differences in anesthetic care: less invasive monitoring (76.1% vs. 93.1%, P < 0.001) and epidural pain management (22.5% vs. 62.9%, P < 0.001). Both cohorts had similar rates of VTE prophylaxis and SSI prevention compliance. CONCLUSION: High and low mortality hospitals both have high compliance with common quality measures; however, HMHs performed worse in other areas of perioperative care, indicating possible targets for quality improvement efforts.