Comparison of risk adjusted excess post-operative pancreatic fistula rates after pancreaticoduodenectomy using cumulative sum analysis.

BACKGROUND: Post-operative pancreatic fistula (POPF) is a key outcome post pancreaticoduodenectomy. There are numerous POPF risk calculators but no agreed benchmark, a key component of meaningful audit. We compared observed versus predicted POPF for six risk adjusted POPF calculators, to ascertain how they differ and thus contribute to discussion around benchmarking. METHODS: This was a retrospective single-arm cohort study at the Royal Melbourne Hospital of patients who underwent pancreaticoduodenectomy 1 November 2015 to 31 December 2021 with a primary outcome of a clinically relevant POPF. Cumulative sum (CUSUM) plots of observed versus predicted rate of POPF for sequential patients were constructed for six risk adjusted POPF calculators - Birmingham, updated Birmingham, fistula risk score (FRS), modified FRS (m-FRS), alternative FRS (a-FRS), and updated alternative FRS (ua-FRS). RESULTS: The study included 77 patients. The actual rate of clinically relevant POPF was 14.3%. FRS calculated an excess of 1.3 POPF per 100 cases. All other calculators demonstrated prevention of POPF per 100 cases: Birmingham 3.4, updated Birmingham 14.0, m-FRS 0.3, a-FRS 1.2, ua-FRS 19.7. CONCLUSION: The observed versus predicted rate of POPF was near zero for all risk calculators except ua-FRS and updated Birmingham, which predicted a higher POPF than observed (19.7, 14.0, respectively). These results indicate that, excepting ua-FRS and updated Birmingham, these calculators yield comparable results. Benchmarks for POPF should prescribe which risk calculators are used, and ideally a unified standard between centres should be the goal to provide consistency in outcome reporting and robust audit processes.

Public perception of the field of plastic surgery.

BACKGROUND: This study aims to assess the public's understanding of the scope of the practice of plastic surgeons, to determine if there is a need to increase awareness of the nature of a plastic surgeon's work. METHODOLOGY: A cross-sectional study was performed. Participants were systematically selected from the White Pages for a telephone survey. The participants' demographics were recorded. Participants were excluded if they or anyone they knew had prior interactions with a plastic surgeon. Participants selected the most common area of specialization of plastic surgeons. The final set of questions determined their choice of surgeon in three different scenarios: breast reduction, excision of skin cancer from the facial region and hand trauma. RESULTS: Two hundred and thirteen of the 257 participants were eligible to complete the survey. Sixty-five per cent were female, with 38% between the ages of 46 and 65 years. The dominant field of practice was reconstructive surgery (36%). Just 19% of participants would consult plastic surgeons across the three clinical scenarios. Dermatologists (47%) were chosen over plastic surgeons (24%) to excise skin cancers from the face. Breast surgeons (53%) were chosen over plastic surgeons (23%) to perform breast reduction surgery. In hand trauma, 58% of participants would consult a hand surgeon and merely 10% would consult with plastic surgeons. DISCUSSION: The general public's understanding of plastic surgery is poor. This may be linked to the misunderstanding of specialist titles and lack of education regarding this field.