Objective: We aimed to determine the impact of surgical experience and frequency of practice on perioperative\nmorbidity and mortality in pancreatic surgery.\nMethods: 1281 patients that underwent pancreatic resections from 1993 to 2013 were retrospectively analyzed using\nlogistic regression models. All cases were stratified according to the surgeonâ??s level of experience, which was based on\nthe number of previously performed pancreatic resections and the extent of received supervision (novice: n < 20 /\nintensive; intermediate: n =21-90 / decreasing; and experienced surgeon: n > 90 / none). Additional stratification was\nbased on the frequency of practice (sporadic: 3 resections > 6 weeks, frequent: 3 resections less than equal to6 weeks).\nResults: The novice and experienced categories were related to a decreased risk of postoperative pancreatic fistulas\n(odds ratio [OR] 0.46, 95% confidence interval [CI] 0.26-0.82 and 0.54, 95% CI 0.36-0.82) and in-hospital mortality (OR 0.45,\n95% CI 0.17-1.16 and 0.42, 95% CI 0.21-0.83) compared to the intermediate category. Frequent practice was associated\nwith a significantly lower risk of delayed gastric emptying (OR 0.56, 95% CI 0.38-0.83), postpancreatectomy hemorrhage\n(OR 0.64, 95% CI 0.42-0.98) and in-hospital mortality (OR 0.45, 95% CI 0.24-0.87).\nConclusions: Our results emphasize the importance of supervision within a pancreatic surgery training program. In\naddition, our data underline the need of a sufficient patient caseload to ensure frequent practice.
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