Survey on Hospital Factors Affecting Failure to Rescue in Pancreatic Surgery - PancreasGroup.org 2 Introduction We are conducting a global survey to understand the importance of hospital-related factors that may influence Failure to Rescue (FTR) after pancreatic surgery. So far, factors related to FTR after pancreatic surgery are mainly investigated on a patient- or hospital volume level. Potentially modifiable hospital-related aspects however are poorly investigated, and their understanding might contribute significantly to reducing FTR rates after pancreatic surgery. Factors particularly pertinent to FTR after pancreatic surgery are listed below, and we would like you, as an expert in pancreatic surgery, to rate them according to your personal experience at your institution. This survey is consisted of 10 domains and 18 questions directly related to failure to rescue. I would take less than 10 min to complete. The deadline for submission is 20 December 2023. Your insights are crucial for understanding the significance of potentially modifiable risk factorsrelated to FTR after pancreatic surgery, thus advancing patient care and safety standards worldwide. Personal Information Please provide your personal and institution infromation exactly as you would like them to appear in future publications. 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This is optional. Local collaborators will be listed as PubMed cited group authors as well. Local Collaborator 1 Local Collaborator 2 Survey All fields are mandatory for submission of this survey. 1. Specialized Care and Expertise Pancreatic surgery requires specialized surgical skills and postoperative care. Hospitals without sufficient expertise may have higher rates of FTR due to inadequate knowledge and experience in managing postoperative complications specific to pancreatic surgery [1,2]. 1a. How important do you rate having specialized surgical skills and knowledge in pancreatic surgery to prevent failure to rescue (FTR) in your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 1a. Availability at my institution Yes No 1b. How important would you rate the presence or absence of specialized pancreatic surgical teams or units within an institution in influencing failure to rescue FTR? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 1b. Availability at my institution Yes No 2. Volume-Outcome Relationship Hospitals that perform a higher volume of complex abdominal surgeries tend to have better outcomes, as the surgical teams at these hospitals are more experienced in managing such complex cases  2a. In your experience, how significant is the volume-outcome relationship, i.e., performing a higher number of pancreatic surgeries over a certain time, in preventing failure to rescue (FTR) in your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 2b. Availability at my institution Yes No 3. Advanced Monitoring and Response Pancreatic surgery patients require close monitoring postoperatively due to the risk of severe complications such as pancreatic fistula, sepsis and hemorrhage. The lack of advanced monitoring techniques and immediate intervention strategies might affect the detection of complications and the management thereof [3,4]. 3a. How do you rate the importance of advanced monitoring techniques of patients in an intensive care or advanced care unit immediately post-pancreatic surgery in influencing failure to rescue (FTR)? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 3a. Availability at my institution Yes No 3b. How would you rate the importance of adhering to monitoring protocols to quickly address complications, in influencing failure to rescue (FTR) outcomes? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 3b. Availability at my institution Yes No 4. Prevention of Delayed Response Failure to recognize early signs of complications can delay necessary interventions. Inadequate rapid response systems and a lack of efficient systems to respond to emergencies may result in delayed treatment of complications . 4a. How important do you rate the efficiency of rapid response or code teams in influencing failure to rescue (FTR) outcomes after pancreatic surgery? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 4a. Availability at my institution Yes No 4b. How critical do you rate bureaucratic delays in obtaining necessary approvals or referrals within the hospital system for interventions such as interventional radiology or surgical procedures in determining failure to rescue FTR rates? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 4b. Availability at my institution Yes No 5. Availability of Specialized Units and Infrastructure The complexity of pancreatic surgery necessitates continued specialized postoperative care, including intensive care units equipped to handle complications such as hemorrhage, infections, organ failure, as well as interventional radiology and endoscopy units. The continued availability of such units after patients have been stepped down to ward-level might influence outcomes [1,3,4]. 5a. How significant is the continued availability and capacity of specialized intensive care units for advanced monitoring and care for patients experiencing severe complications after pancreatic surgery? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 5a. Availability at my institution Yes No 5b. How important do you rate to availability of a specialized units such as interventional radiology or advanced endoscopy (e.g. ERCP) within the hospital where the pancreatic surgery was performed in preventing failure to rescue (FTR)? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 5b. Availability at my institution Yes No 5c. How crucial do you rate hospital resources to sustain poorly maintained or outdated facilities and equipment that can compromise patient care highest standards with regards to failure to rescue (FTR)? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 5c. Availability at my institution Yes No 6. Clinical Guidelines and Protocols The absence of clear and up-to-date clinical guidelines and standardized protocols, including enhanced recovery after surgery (ERAS) protocols, influences the managing complications specific to pancreatic surgery and for patient discharge from intensive care or hospital units . 6a. How important do you rate the adherence to clinical guidelines and standard operating procedures, and the documentation of deviations from the protocol, for managing complications specific to pancreatic surgery and preventing failure to rescue (FTR) in your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 6a. Availability at my institution Yes No 6b. How crucial is the adherence to appropriate discharge policies, to prevent premature discharge of patients e.g. due to pressure on bed availability, in affecting missed complications and failure to rescue (FTR) in your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 6b. Availability at my institution Yes No 7. Multidisciplinarity and Hospital Culture A multidisciplinary approach involving surgeons, gastroenterologists, radiologists, interventional radiologists, pathologists, and other specialists is crucial for managing complications after pancreatic surgery. Hospitals lacking a coordinated multidisciplinary approach and an inconsistent adherence to best practices, may face difficulties in managing complications effectively [5,6] 7a. How important is the availability and coordination of a multidisciplinary team setting and dedicated meetings involving various specialists for managing complications after pancreatic surgery in your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 7a. Availability at my institution Yes No 7b. How important is the institution's openness to adopting newer, evidence-based practices in influencing failure to rescue (FTR)? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 7b. Availability at my institution Yes No 8. Postoperative Nutritional Support Proper nutritional support from specialized dieticians is crucial after pancreatic surgery, and failure to provide adequate nutrition may increase the risk of complications impacting a patient’s recovery . 8a. How critical do you rate the administration of proper nutritional support and counselling after pancreatic surgery in preventing failure to rescue FTR in your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 8a. Availability at my institution Yes No 9. Staffing and Training Inadequate number of nursing staff or medical professionals to monitor postoperative patients effectively, and / or a lack of sufficient training and experience among the staff to recognize and manage complications promptlymay affect outcomes 9a. How crucial do you rate the influence of nurse-to-patient ratios in specialized units to prevent failure to rescue (FTR) after pancreatic surgery in your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 9a. Availability at my institution Yes No 10. Communication and Coordination Inadequate communication during shift changes can lead to the omission of critical information about the patient’s condition. Failure in the coordination and communication among different members of the healthcare team can delay intervention . 10a. How significant do you judge effective communication and coordination among different healthcare teams in preventing failure to rescue (FTR) after pancreatic surgery in your institution? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 10a. Availability at my institution Yes No 10b. How critical do you rate the importance of an efficient handover between shifts with regard to preventing failure to rescue (FTR) outcomes? 0 1 2 3 4 5 6 7 8 9 10 Not at allExtremely 10b. Availability at my institution Yes No Additional Insights Please provide any additional insights, considerations, or factors that you believe are significant in preventing FTR after pancreatic surgery in your institution. Additional insights References Moazzam Z, Lima HA, Alaimo L, Endo Y, Ejaz A, Beane J, et al. Hepatopancreatic Surgeons Versus Pancreatic Surgeons: Does Surgical Subspecialization Impact Patient Care and Outcomes? J Gastrointest Surg 2023;27:750–9. https://doi.org/10.1007/s11605-023-05639-3. El Amrani M, Clement G, Lenne X, Farges O, Delpero J-R, Theis D, et al. Failure-to-rescue in Patients Undergoing Pancreatectomy: Is Hospital Volume a Standard for Quality Improvement Programs? Nationwide Analysis of 12,333 Patients. Ann Surg 2018;268:799–807. https://doi.org/10.1097/SLA.0000000000002945. Nymo LS, Kleive D, Waardal K, Bringeland EA, Søreide JA, Labori KJ, et al. Centralizing a national pancreatoduodenectomy service: striking the right balance. BJS Open 2020;4:904–13. https://doi.org/10.1002/bjs5.50342. Suurmeijer JA, Henry AC, Bonsing BA, Bosscha K, van Dam RM, van Eijck CH, et al. Outcome of Pancreatic Surgery During the First 6 Years of a Mandatory Audit Within the Dutch Pancreatic Cancer Group. Ann Surg 2023;278:260–6. https://doi.org/10.1097/SLA.0000000000005628. Gleeson EM, Pitt HA, Mackay TM, Wellner UF, Williamsson C, Busch OR, et al. Failure to Rescue After Pancreatoduodenectomy: A Transatlantic Analysis. Ann Surg 2021;274:459–66. https://doi.org/10.1097/SLA.0000000000005000. Ansari D, Gustafsson A, Andersson R. Update on the management of pancreatic cancer: surgery is not enough. World J Gastroenterol 2015;21:3157–65. https://doi.org/10.3748/wjg.v21.i11.3157. Gianotti L, Besselink MG, Sandini M, Hackert T, Conlon K, Gerritsen A, et al. Nutritional support and therapy in pancreatic surgery: A position paper of the International Study Group on Pancreatic Surgery (ISGPS). Surgery 2018;164:1035–48. https://doi.org/10.1016/j.surg.2018.05.040.