The Impact of Postoperative Complications on the Administration of Adjuvant Therapy Following Pancreaticoduodenectomy for Adenocarcinoma

ABSTRACT Background. The impact of postoperative complications on the administration of adjuvant therapy following pancreaticoduodenectomy (PD) for adenocarcinoma is still unclear. Methods. A retrospective review of all patients undergoing PD at our institution between 1995 and 2011 was performed. Clinicopathological data, including ClavienDindo complication grade, time to adjuvant therapy (TTA), and survival, were analyzed. Approximately 45,200 cases of pancreatic cancer (PC) are diagnosed yearly in the US, with 38,500-attributable cancer-related deaths. 1 The overall 5-year survival rate for PC is only 6 %, 1 and even for resectable cancers, the 5-year survival rate following pancreaticoduodenectomy (PD) is less than 20 %. 2-7 Local and systemic recurrence are common following PD, suggesting both systemic and local adjuvant therapy are necessary to improve outcomes

Impact of preoperative briefings on operating room delays: a preliminary report

Hypothesis: Preoperative briefings have the potential to reduce operating room (OR) delays through improved teamwork and communication. Design: Pre-post study. Setting: Tertiary academic center. Participants: Surgeons, anesthesiologists, nurses, and other OR personnel. Intervention: An OR briefings program was implemented after training all OR staff in how to conduct preoperative briefings through in-service training sessions. During the preoperative briefings, the attending surgeon led OR personnel in a 2-minute discussion using a standardized format designed to familiarize caregivers with each other and the operative plan before each surgical procedure. Main Outcome Measures: The OR Briefings Assessment Tool was distributed to OR personnel at the end of each operation. Survey items questioned OR personnel about unexpected delays during each procedure and the relationship between communication breakdowns and delays. Responses were compared before and after the initiation of the preoperative briefings program. Results: The use of preoperative briefings was associated with a 31% reduction in unexpected delays; 36% of OR personnel reported delays in the preintervention period, and 25% reported delays in the postintervention period (PϽ.04). Among surgeons alone, an 82% reduction in unexpected delays was observed (PϽ.001). A 19% reduction in communication breakdowns leading to delays was also associated with the use of briefings (PϽ.006). Conclusions: Preoperative briefings reduced unexpected delays in the OR by 31% and decreased the frequency of communication breakdowns that lead to delays. Preoperative briefings have the potential to increase OR efficiency and thereby improve quality of care and reduce cost