title: How Does Outcomes Research Help Advance Our Knowledge of Patient Outcomes in Hepatopancreaticobiliary Surgery?
abstract: Randomized controlled trials have historically been regarded as the gold standard of modern clinical research tools, allowing us to elucidate the efficacy of novel therapeutics in an unparalleled manner. However, when attempting to generalize trial results to broader populations, it becomes apparent that the unexplained outcome variability exists among treatment recipients, suggesting that randomized controlled trials harbor inherent limitations. Herein, we explore the benefits of health services (outcomes) research utilization in addressing variation in patient outcomes following surgical intervention in the non-randomized setting, with a specific focus on hepatopancreaticobiliary surgery outcomes. To achieve this, we have constructed a framework that outlines the complex interactions existing between therapeutic, patient, and provider factors that subsequently lead to variation in outcomes. By exploring examples in the current literature, we have highlighted the areas where the knowledge is currently lacking and can be further strengthened through the application of outcomes research. Furthermore, we have attempted to demonstrate the utility of alternative study designs in the investigation of novel clinical questions currently unanswered in the field of hepatopancreaticobiliary surgery.
authors: Department of Surgery, Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Boston, MA, 02114, USA.
authors: Donna Marie L
authors: DM
authors: Alvino
authors: Department of Surgery, Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Boston, MA, 02114, USA.
authors: David C
authors: DC
authors: Chang
authors: Department of Surgery, Codman Center for Clinical Effectiveness in Surgery, Massachusetts General Hospital, Harvard Medical School, 165 Cambridge Street, Boston, MA, 02114, USA. zfong@partners.org.
authors: Zhi Ven
authors: ZV
authors: Fong
mesh_terms: D001662:Biliary Tract Surgical Procedures; D006801:Humans; D019359:Knowledge; D008099:Liver / Q000601:surgery*; D017063:Outcome Assessment, Health Care; D010179:Pancreas / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D012107:Research Design
keywords: Health services research; Hepatopancreaticobiliary surgery; Outcomes; Pancreas