Association of Advanced Practice Providers Integration With Postoperative Outcomes in Pancreatic Surgery

Abstract

Introduction: Complications after pancreatic surgery occur in 30%-50% of patients, with readmission rates reported up to 30%-40%. We integrated an Advanced Practice Provider (APP) into our pancreatic surgery team to identify postoperative issues early and improve continuity of care. We implemented an APP led structured follow-up protocol to explore if this was associated with readmission rates, length of stay (LOS), mortality, and failure-to-rescue (FTR) rates in patients undergoing pancreatic surgery.

Methods: This single-institution, retrospective study included patients who underwent pancreatic resection from 2019 to 2024, categorized into pre-APP (January 2019-September 2022) and post-APP (January 2023-February 2024) groups. The goal was for the APP to evaluate all patients within 72 h of discharge. Outcomes included readmission rates, LOS, mortality, and FTR rates.

Results: A total of 290 patients were included, with 191 in the pre-APP group and 99 in the post-APP group. The average age of the total cohort was 65.5 ± 13.4 ys with 57.2% undergoing a pancreaticoduodenectomy. Between groups, the post-APP group had lower Charlson-Comorbidity Index scores (3.8 ± 2.2 versus 4.6 ± 2.0, P < 0.01), surgery was more likely a minimally invasive approach (11.1% versus 4.7%, P = 0.04), and was more likely indicated for benign pathology compared to the pre-APP group (40.4% versus 19.9%, P < 0.01). In the post-APP group, 48.5% of patients were seen within 72 h, and when compared to the pre-APP group, patients had shorter index hospitalization LOS (6.9 versus 8.6 ds, P = 0.01), earlier first postoperative visits (4.9 versus 10.1 ds, P < 0.01), and the time to readmission after discharge was shorter (8.1 ± 5.8 versus 11.3 ± 5.7, P = 0.05). Although not significantly different, both 30-d mortality (1.0% versus 4.2%, P = 0.17) and FTR rates (1.6% versus 5.8%, P = 0.28) were lower in the post-APP group.

Conclusions: Integration of an APP with a structured follow-up protocol was associated with earlier identification of complications, shorter LOS, and lower mortality.

Keywords: Advanced practice providers (APP); Pancreatic surgery; Postoperative outcomes.