BACKGROUND The data within the Australian and New Zealand Audit of Surgical Mortality (ANZASM) provides a unique opportunity to consider the contributing factors to perioperative deaths as determined by peer review. Consideration of the factors contributing to mortality after pancreaticoduodenectomy (PD) can provide greater insight into how deaths can be prevented. METHODS ANZASM data from 1 January 2010 to 30 Jun 2017 was reviewed and all deaths following PD were selected for analysis. Assessor's determination of whether management could have been improved were reviewed and classified into groups of significant clinical events using thematic analysis with a data driven approach. RESULTS The study included 87 deaths reported to ANZASM after PD. Forty-two major complications were considered significant clinical events in 29/84 (35%) of patients. The assessor determined that there was a delay in recognising a significant complication in 18/84 (21%) of patients. In 14/84 (17%) of patients, ANZASM assessment questioned the decision to operate. CONCLUSION Multi-disciplinary decision making is strongly recommended when deciding which patients to treat with PD. Late recognition, and therefore delayed action to treat complications, in almost a quarter of deaths is a significant finding that warrants consideration for clinicians involved in the postoperative care of PD patients.

中文翻译：

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在澳大利亚进行胰十二指肠切除术后死亡率的同行评审。

背景技术澳大利亚和新西兰外科手术死亡率审核（ANZASM）中的数据提供了一个独特的机会来考虑由同行评审确定的围手术期死亡的影响因素。考虑胰十二指肠切除术（PD）后导致死亡的因素可以为如何预防死亡提供更深入的了解。方法回顾2010年1月1日至2017年6月30日的ANZASM数据，并选择PD后所有死亡病例进行分析。使用主题分析和数据驱动的方法，评估了评估者对管理是否可以得到改善的确定，并将其分类为重要的临床事件。结果该研究包括PD后向ANZASM报告的87例死亡。在29/84（35％）患者中，有42种主要并发症被认为是重要的临床事件。评估者确定在18/84（21％）的患者中发现重大并发症存在延迟。在14/84（17％）的患者中，ANZASM评估对手术决定提出了质疑。结论在决定治疗哪些患者的PD时，强烈建议进行多学科决策。迟到的认识，因此延迟了并发症的治疗，在近四分之一的死亡中是一个重要发现，值得对参与PD患者术后护理的临床医生进行考虑。结论在决定治疗哪些患者的PD时，强烈建议进行多学科决策。迟到的认识，因此延迟了并发症的治疗，在近四分之一的死亡中是一个重要发现，值得对参与PD患者术后护理的临床医生进行考虑。结论在决定治疗哪些患者的PD时，强烈建议进行多学科决策。迟到的认识，因此延迟了并发症的治疗，在将近四分之一的死亡中是一个重要发现，值得参与PD患者术后护理的临床医生考虑。