308 Risk-Adjusted Postoperative Pancreatic Fistula Rates Decrease Throughout the Career of Pancreatic Surgeons: A Longitudinal Cohort Study

Abstract Aim Postoperative pancreatic fistula (POPF) remains the principal source of morbidity and mortality after pancreatoduodenectomy (PD). Patient factors are strongly linked to POPF though the role of surgeon experience is poorly defined and largely neglected in studies seeking to determine variation in POPF. The aim of this study is to report how surgeon experience influences risk-adjusted POPF rates throughout their careers. Method Patients undergoing PD were identified from a prospectively maintained database. To investigate the effect of surgeon experience on risk-adjusted POPF rates, only surgeons who had performed their first PD as a Consultant during the study period were included. Trends in risk-adjusted POPF rates were then investigated for each surgeon using cumulative sum (CUSUM) analysis using an externally validated POPF risk score. Results Seven surgeons and a total of 795 PDs were included. CUSUM analysis for each surgeon demonstrated a reduction in risk-adjusted POPF rates across their career. Combined risk-adjusted POPF rates were investigated for all surgeons during the early (0-50 PDs), middle (51-100 PDs) and late (101-150 PDs) portions of their careers. This demonstrated a reduction in risk-adjusted POPF rates as surgeons progress through their careers, from early (expected 24% vs. observed 24%) to middle (expected 26% vs. observed 18%; relative reduction 25%) and late (expected 30% vs. observed 20%; relative reduction 33%). Conclusions Risk-adjusted POPF rates reduce as pancreatic surgeons gain more experience. Understanding the mechanisms by which acquired experience reduces POPF rates could accelerate surgeon development. CUSUM analysis is a unique tool for surgeons to benchmark practice to their peers.