LAUSR

OBJECTIVE To determine the safety of a fully functioning shared care model (SCM) in hepatopancreatobiliary surgery through evaluating outcomes in pancreaticoduodenectomy. SUMMARY BACKGROUND DATA SCMs, where a team of surgeons share in care delivery and resource utilization, represent a surgeon-level opportunity to improve system efficiency and peer support, but concerns around clinical safety remain, especially in complex elective surgery. METHODS Patients who underwent pancreaticoduodenectomy between 2016-2020 were included. Adoption of shared care was demonstrated by analyzing shared care measures including the number of surgeons encountered by patients during their care cycle, proportion of patients with different consenting versus primary operating surgeon (POS), and the proportion of patients who met their POS on the day of surgery. Outcomes including 30-day mortality, readmission, unplanned reoperation, sepsis, and length of stay (LOS) were collected from the institution's National Surgical Quality Improvement Program (NSQIP) database and compared to peer hospitals contributing to the pancreatectomy-specific NSQIP collaborative. RESULTS Of the 174 patients included, a median of three surgeons were involved throughout the patients' care cycle, 69.0% of patients had different consenting versus POS, and 57.5% met their POS on the day of surgery. Major outcomes including mortality (1.1%), sepsis (5.2%), and reoperation (7.5%) were comparable between the study group and NSQIP peer hospitals. LOS (10 d) was higher in place of lower readmission (13.2%) in the study group compared to peer hospitals. CONCLUSIONS SCMs are feasible in complex elective surgery without compromising patient outcomes, and wider adoption may be encouraged.