Postoperative Standardization of Care: the Implementation of Best Practice After Pancreatic Resection. A nationwide stepped-wedge cluster randomized trial.

INTERVENTION: This trial evaluates a cluster level intervention in which clinicians involved in the postoperative care for patients undergoing pancreatic resection are informed on the best practice algorithm for early detection and minimally invasive management of postoperative pancreatic fistula. To evaluate the effect of this intervention in terms of decreasing the risk of major complications and death, outcomes of patients undergoing pancreatic resection before implementation (i.e. current practice) will be compared to outcomes of patients undergoing pancreatic resection after implementation of the algorithm (i.e. best practice). CONDITION: Pancreatic cancer, Pancreatic fistula ; ; PRIMARY OUTCOME: Composite primary endpoint: post‐pancreatectomy bleeding, new‐onset organ failure or mortality SECONDARY OUTCOME: Secondary endpoints include the individual components of the primary endpoint and other clinical outcomes, healthcare resource utilization, number of patients receiving adjuvant chemotherapy and costs analysis. INCLUSION CRITERIA: CLUSTERS: All centers performing pancreatic surgery in The Netherlands (the DPCG centers) are included in this study. PATIENTS: Outcomes of all patients undergoing pancreatic resection in The Netherlands in the study period will be evaluated