Background

The centralization of pancreatoduodenectomy (PD) has been shown to improve patient outcomes. The scheduling of two PDs in one day is one option to shorten the waiting time for patients referred to high volume centers. The effect on the surgical team or patient outcomes of such an approach have not previously been explored. This study aimed to investigate the effect of scheduling two PDs in one day on the surgeon's workload and patient outcomes.

Methods

A retrospective review of patients undergoing PD by a single surgeon between 2007 and 2018 was performed. Patients were allocated into: first PD (FIRSTPD group) or second PD (SECONDPD group) according to the position on the surgical operating list. The intraoperative, postoperative outcomes, and workload (the Surgery Task Load Index; SURG-TLX) were assessed between two groups.

Results

A total of 967 (91%) and 101 (9%) patients were included in the FIRSTPD and SECONDPD group, respectively. There were no differences in the duration of surgery (coefficient = −9.65; 95% confidence interval: −29.26 to 9.94; P = 0.334), incidence of major complications (odds ratio = 1.08; 95% confidence interval: 0.67–1.73; P = 0.739), or 90-day mortality (odds ratio = 1.03; 95% confidence interval: 0.12–8.53; P = 0.978) for those patients in the SECONDPD group as compared to the FIRSTPD group. The mean scores of two (physical and temporal demand) of the six SURG-TLX subscales of surgical workload were recorded as significantly higher by surgeons following two PD's as compared to one PD.

Conclusions

Although scheduling a second PD in one day shows no association with adverse patient outcomes, there is an increase in the physical and temporal subscales of surgical workload and consideration should be given to how this could be minimized.

中文翻译：

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一个手术团队在一天内进行两次胰十二指肠切除术对外科医生和患者预后的影响。

背景

胰十二指肠切除术 (PD) 的集中化已被证明可以改善患者的预后。在一天内安排两个 PD 是缩短转诊到高容量中心的患者等待时间的一种选择。以前没有探索过这种方法对手术团队或患者结果的影响。本研究旨在调查在一天内安排两次 PD 对外科医生工作量和患者预后的影响。

方法

对 2007 年至 2018 年间由一名外科医生进行的 PD 患者进行了回顾性研究。根据手术操作清单上的位置，将患者分为：第一PD（FIRSTPD组）或第二PD（SECONDPD组）。评估两组的术中、术后结果和工作量（手术任务负荷指数；SURG-TLX）。

结果

FIRSTPD 和 SECONDPD 组分别包括 967 名 (91%) 和 101 名 (9%) 患者。手术持续时间（系数 = -9.65；95% 置信区间：-29.26 至 9.94；P  = 0.334）、主要并发症发生率（优势比 = 1.08；95% 置信区间：0.67-1.73；P = 0.739），或 与 FIRSTPD 组相比，SECONDPD 组患者的 90 天死亡率（优势比 = 1.03；95% 置信区间：0.12-8.53；P = 0.978）。手术工作量的​​六个 SURG-TLX 分量表的两个（身体和时间需求）的平均得分被记录为在两个 PD 之后的外科医生明显高于一个 PD。

结论

尽管在一天内安排第二次 PD 与患者的不良结果无关，但手术工作量的​​物理和时间分量表有所增加，应考虑如何将其最小化。