Journal
JOURNAL OF GASTROINTESTINAL SURGERY
Volume 21, Issue 3, Pages 506-515Publisher
SPRINGER
DOI: 10.1007/s11605-016-3346-1
Keywords
Pancreaticoduodenectomy; Pancreatic cancer; Surgical complication; Hospital volume
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Funding
- Cancer Research Society
- Rob Lutterman Memorial Fund
- Institute for Clinical Evaluative Sciences (ICES) - Ontario Ministry of Health and Long-Term Care (MOHLTC)
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Performance of pancreaticoduodenectomy (PD) in high-volume centers has been posited to improve postoperative morbidity and mortality, consistent with the volume-outcomes hypothesis. We sought to evaluate the impact of hospital volume on 90-day PD outcomes at hepatopancreatobiliary (HPB) centers within a regionalized system. A retrospective population-based observational cohort study was performed, using administrative records of patients undergoing PD between 2005 and 2013 in Ontario, Canada. Postoperative administrative codes were used to define complications. Patients' 90-day postoperative outcomes were compared between center-volume categories using chi-square tests and multivariable regression. Volume cutoffs were defined using minimal regional standards (20PD/year), with assessment of the impact of further volume increases. Of 2660 patients, 2563 underwent PD at HPB centers. Of these, 38.9% underwent surgery at higher-volume centers (> 40 PD/year), 36.9% at medium-volume centers (20-39 PD/year), and 24.1% at lower-volume centers (10-19 PD/year). Mortality (30- and 90-day) was lowest at higher-volume hospitals (1.5%, 2.7%, respectively) compared to medium-volume (3.9%, 6.3%) and lower-volume hospitals (2.9%, 5.2%) (p < 0.01). Patients treated at higher- and medium-volume centers had lower reoperation rates (10.3%, 10.7% vs. 16.7%, p = 0.0002) and less prolonged length of stay (23.2%, 22.0% vs. 31.6%, p < 0.0001) compared to lower-volume centers. Progressive increases in hospital volume correspond to improved 90-day outcomes following PD.
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