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The Impact of Increasing Hospital Volume on 90-Day Postoperative Outcomes Following Pancreaticoduodenectomy
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The Impact of Increasing Hospital Volume on 90-Day Postoperative Outcomes Following Pancreaticoduodenectomy
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Journal Article
The Impact of Increasing Hospital Volume on 90-Day Postoperative Outcomes Following Pancreaticoduodenectomy
2017
Overview
Background
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.
Methods
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.
Results
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.
Conclusion
Progressive increases in hospital volume correspond to improved 90-day outcomes following PD.
Publisher
Springer US,Springer Nature B.V
Subject
/ Female
/ Hospitals, High-Volume - statistics & numerical data
/ Hospitals, Low-Volume - statistics & numerical data
/ Humans
/ Length of Stay - statistics & numerical data
/ Male
/ Medicine
/ Oncology
/ Pancreaticoduodenectomy - adverse effects
/ Pancreaticoduodenectomy - mortality
/ Postoperative Complications - etiology
/ Reoperation - statistics & numerical data
/ Surgeons
/ Surgery
