Approach to postpancreatectomy care impacts outcomes: retrospective validation of the porsch trial

Background In the recent PORSCH trial, a three-part postpancreatectomy care algorithm was employed with a near 50% reduction in mortality. We hypothesized that clinical care congruent with this protocol would correlate with better outcomes in our patients. Methods Real-world postoperative care was compared to the pathway described by the PORSCH trial and patients were assigned into groups based on congruence with its recommendations. The primary composite outcome (PCO) consisted of 90-day mortality, organ failure, and interventions for bleeding. Results Of 289 patients, care of 12% was entirely congruent with the PORSCH algorithm. The PCO was recorded in 9% of the PORSCH care group, 8% of the Partial-PORSCH care group, and 19% of the Non-PORSCH care group (p=0.044). Adverse outcomes were highest when pancreaticoduodenectomy patients received care incongruent with the algorithm’s CT imaging recommendations. Conclusions These results add external validity to the principles of clinical care underlying the PORSCH algorithm.