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KL3 Assessing the Quality of Pancreaticoduodenectomy with Global Metrics<br />
– An International Consensus for Cooperative Commitment<br />
St Luke’s Center for Pancreatic Disease, Boise, Idaho, USA<br />
○L.…William…Traverso…<br />
First…one…must…believe…the…Deming…principle…-…in…order…to…improve…one…must…measure…what…we…do.…In…<br />
order… to…improve…one…must…compare.…Three…criteria…must…be…acquired…in…order…to…compare…outcome…<br />
measurements…between…hospitals…or…surgeons…that…perform…complex…operations…–…chose…the…outcomes…that…<br />
best…reflect…the…quality…of…the…operation,…reach…a…consensus…definition…for…each…outcome,…and…finally…create…<br />
a…simple…yet…standardized…calculator…that…is…web-based.…Outcomes…can…then…be…compared…after…being…<br />
easily…calculated.…The…outcomes…to…measure…for…the…Whipple…operation…include…three…severity…grading…<br />
scales…for…surgical…complications…–…1)…clinically…relevant…postoperative…pancreatic…fistula…or…leak…(POPF),…<br />
2)…clinically…relevant…delayed…gastric…emptying…(DGE),…and…3)…the…Accordion…Severity…Grading…System…<br />
(ASGS),… a… modified… Clavien… grading… scale… of… postoperative… complications.… The… POPF… and… DGE…<br />
measurements…are…defined…with…international…consensus…and…can…be…calculated…with…a…13…question…tool…on…<br />
the…Pancreas…Club…website…(http://pancreasclub.com/calculator/).…For…more…details…look…at…Surgery…<br />
2010;147:…503-515…as…to…how…the…tool…calculates…clinically…relevant…POPF…and…DGE…and…their…definitions.…<br />
Historical…values…for…the…outcome…measurements…of…500…Whipple…operations…are…in…Table…IV…of…that…article.…<br />
The…ASGS…is…calculated…using…a…simple…table…(Grade…0-6,…see…table…below).…The…latter…measurement…<br />
significantly… correlates… with… length… of… hospital… stay…(LOS)… so… LOS… does… not… have… to… be… measured.…<br />
Historical…values…for…the…Whipple…operation…are…listed…in… Low…DE,…et… al.…Comparing…complications…of…<br />
esophagectomy…and…pancreaticoduodenectomy…and…potential…impact…on…hospital…systems…utilizing…the…<br />
Accordion…Severity…Grading…System.…J…Gastrointest…Surg…2010;…14:1646-1652.<br />
Web-based… measurements… using… consensus… definitions… allows… for… international… comparison… and…<br />
improvement…of…this…complex…operation…–…an…international…commitment.<br />
Keynote<br />
Lecture<br />
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