PARANOIA is an open-ended international registry for surgeons to record pancreatoduodenectomy resections, key operative and patient variables and POPF outcomes. This registry will become a rich resource to explore POPF, and uniquely, will provide surgeons with their own risk adjusted outcomes and CUSUM plots.
Postoperative pancreatic fistula (POPF) is the single most important complication following pancreatoduodenectomy (PD), impacting hospital stay and cost, complications and post-operative mortality. Furthermore, POPF may delay, if not all together deny patients with cancer the opportunity to receive adjuvant chemotherapy. Clinically relevant POPF (CR-POPF) affects around 15% of patients and is associated with a large financial burden where its occurrence doubles healthcare costs.
Despite advances in technology and healthcare, POPF remains the single largest problem of pancreatic surgery. It is the single most researched factor in pancreatic surgery. However, relatively small numbers of patients operated upon by individual units and poorly conducted trials means that the majority of research in this field has been underpowered, and likely the cause of many negative trials.
With the help of a steering committee of established international experts and through collaborating with surgeons across the globe, we will ensure the research is high profile, gains traction and effects change.
Overview
Potential
This work will provide three entirely novel systems:
(1) anonymised surgeons risk adjusted outcome data and an ability to use the registry to explore techniques which are associated with a low rate of POPF by other surgeons; any change in surgeons practice can be observed in real time through the use of CUSUM plots
(2) an international, freely accessible, registry for the study of POPF risk factors
(3) a stable platform the conduct of clinical trials.
Anonymised
Risk adjusted outcome data
CUSUM
International
Freely accessisble registry
Stable platform to conduct clinical trials
CUSUM
What is CUSUM?
Cumulative sum (CUSUM) analysis is a graphical representation of the trend in outcomes from a series of consecutive procedures over time. The outcome is binary (ie. The event occurred- Yes or No) and so the observed deviation from the expected outcome allows changes in performance and trends to provide useful feedback.
Advantages of CUSUM analysis in POPF
The use of POPF, as a measure of surgical performance, is attractive as it is strongly related to subsequent adverse outcomes such as mortality whilst it’s occurrence is roughly 6–10 times more frequent than mortality.
Get involved
Getting involved requires a few easy steps.
Fill in the registration survey and get your log in details for the registry
Start inputting cases into the registry to get your CUSUMS