Patient selection and the volume effect in pancreatic surgery: unequal benefits?. Issue 10 (6th June 2014)

• Record Type: Journal Article
• Authors: Bliss, Lindsay A.; Yang, Catherine J.; Chau, Zeling; Ng, Sing Chau; McFadden, David W.; Kent, Tara S.; Moser, A. James; Callery, Mark P.; Tseng, Jennifer F.
• Is Part Of: HPB. Volume 16:Issue 10(2014:Oct.)
• Page Start: 899
• Page End: 906
• Publication Date: 2014-06-06
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1111/hpb.12283
• Languages: English
• ISSNs: 1365-182X

Abstract

<abstract abstract-type="main"> <title>Abstract</title> <sec id="hpb12283-sec-0001" sec-type="section"> <title>Background</title> <p>The volume effect in pancreatic surgery is well established. Regionalization to high‐volume centres has been proposed. The effect of this proposal on practice patterns is unknown.</p> </sec> <sec id="hpb12283-sec-0002" sec-type="section"> <title>Methods</title> <p>Retrospective review of pancreatectomy patients in the Nationwide Inpatient Sample 2004–2011. Inpatient mortality and complication rates were calculated. Patients were stratified by annual centre pancreatic resection volume (low <5, medium 5–18, high >18). Multivariable regression model evaluated predictors of resection at a high‐volume centre.</p> </sec> <sec id="hpb12283-sec-0003" sec-type="section"> <title>Results</title> <p>In total, 129 609 patients underwent a pancreatectomy. The crude inpatient mortality rate was 4.3%. 36.0% experienced complications. 66.5% underwent a resection at high‐volume centres. In 2004, low‐, medium‐ and high‐volume centres resected 16.3%, 24.5% and 59.2% of patients, compared with 7.6%, 19.3% and 73.1% in 2011. High‐volume centres had lower mortality (<italic>P</italic> < 0.001), fewer complications (<italic>P</italic> < 0.001) and a shorter median length of stay (<italic>P</italic> < 0.001). Patients at non‐high‐volume centres had more comorbidities (<italic>P</italic> = 0.001), lower rates of private insurance (<italic>P</italic> < 0.001) and more non‐elective admissions (<italic>P</italic> < 0.001).</p> </sec> <sec id="hpb12283-sec-0004" sec-type="section"> <title>Discussion</title> <p>In spite of a shift to high‐volume hospitals, a substantial cohort still receives a resection outside of these centres. Patients receiving non‐high‐volume care demonstrate less favourable comorbidities, insurance and urgency of operation. The implications are twofold: already disadvantaged patients may not benefit from the high‐volume effect; and patients predisposed to do well may contribute to observed superior outcomes at high‐volume centres.</p> </sec> </abstract>