App prevents death after removal of the pancreas

If doctors and nurses use a specially developed app to keep an eye on their patients, they are significantly less likely to develop life-threatening complications after pancreatic surgery. That appears from a study in seventeen Dutch hospitals which appeared last week in the medical-scientific journal The Lancet† In the app, doctors and nurses can not only keep track of daily readings, the algorithm also provides advice on what to do if a complication threatens.

In people with pancreatic cancer, that organ, a large gland just below the stomach, can sometimes be removed. There is a high risk of complications after this complicated operation. Most commonly, fluid leaks from the surgical site into the abdominal cavity. Depending on how often a hospital performs the surgery, it happens after 3 percent to 45 percent of operations, US cancer surgeon Eliza Beal writes. in an accompanying commentary in The Lancet† In the Netherlands it happens on average in one in three patients.

Stop Organs

Leaking can have serious consequences. The patient may have internal bleeding, the organs may stop working, and in the worst case scenario, he or she may die. Complications are often not noticed until the patient develops symptoms, and then it is sometimes too late. With the app, doctors are there earlier.

All Dutch hospitals that perform the operation against pancreatic cancer took part in the study. All surgeons, doctors, nurses, radiologists and ICU staff involved learned to use the app.

In the nearly two years that the study ran, 1,748 people had surgery. Of these, 863 people were monitored with the app after surgery. The other half received the usual care: their disease course was recorded in an electronic patient file.

After the complicated operation there is a high risk of complications

The app differs from the regular electronic patient record. In both care providers can enter all kinds of medical and biochemical values. But the algorithm in the app is designed to detect complications as early as possible and make suggestions for treatment. When these values ​​exceed predetermined limits, the app can recommend, for example, a CT scan of the abdomen, placing or removing a drain, or giving antibiotics.

To build the algorithm, the researchers used the existing medical literature, the guidelines for post-operative care and the outcomes of joint meetings. Three independent international pancreatic experts reviewed the algorithm before it was put into use.

In the group whose caregivers did not use the app, 124 people (14 percent) experienced a life-threatening complication: bleeding or organ failure; 44 patients (5 percent) died in the three months after surgery. In the group in which the app was used, this was significantly lower: 73 people (8 percent) developed a life-threatening complication, 23 patients (2.7 percent) died – almost half the number. Fewer people had to be operated on again in that group, they received less invasive treatment with antibiotics or drainage more often and earlier.

Compliance

When using the app, care improved in all hospitals, both those where the surgery was performed frequently and in hospitals where the procedure is performed less frequently, and the risk of complications and death is higher.

The authors noted that in some hospitals, pancreatic surgeons did not always follow the algorithm’s recommendations — compliance was between 70 and 83 percent. The effect of the algorithm might be even greater if it did, they note.

The algorithm is safe, cheap and easy to use, especially with the app, which can be completed next to the patient’s bed. And the care provided did not become more expensive, the authors write. The app can also be tested and used in the future to monitor aftercare after other types of surgery.

the app, Pancreatic Surgery can be downloaded free of charge for healthcare workers in the app stores for both Apple and Android.

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