OBJECTIVE: To analyze in-hospital mortality after pancreatectomy using a large national database. SUMMARY AND BACKGROUND DATA: Pancreatic resections, including pancreaticoduodenectomy, distal pancreatectomy, and total pancreatectomy, remain the only potentially curative interventions for pancreatic cancer. The goal of this study was to define factors affecting outcomes after pancreatectomy for neoplasm. METHODS: A retrospective analysis was performed using all patients undergoing pancreatic resections for neoplastic disease identified from the Nationwide Inpatient Sample from 1998 to 2003. Crude in-hospital mortality was analyzed by chi. A multivariable model was constructed to adjust for age, sex, hospital teaching status, hospital surgical volume, year of resection, payer status, and selected comorbid conditions. RESULTS: In all, 279,445 patient discharges were identified with a primary diagnosis of pancreatic neoplasm. A total of 39,463 (14%) patients underwent resection during that hospitalization. In-hospital mortality was 5.9% with a significant decrease from 7.8% to 4.6% from 1998 to 2003 by trend analysis (P < 0.0001). Resections done at low (<5 procedures/year)- and medium (5-18/year)-volume centers had higher mortality compared with those at high (>18/year)-volume centers (low-volume odds ratio = 3.3; 95% confidence interval, 2.3-4.; medium-volume, odds ratio = 2.1; 95% confidence interval, 1.5-3.0). The proportion of procedures performed at high volume centers increased from 30% to 39% over the 6-year time period (P < 0.0001) by trend test. CONCLUSIONS: This large observational study demonstrates an improvement in operative mortality for patients undergoing pancreatectomy for neoplastic disease from 1998 to 2003. In addition, a greater proportion of pancreatectomies were performed at high-volume centers in 2003. The regionalization of pancreatic surgery may have partially contributed to the observed decrease in mortality rates.
OBJECTIVE: To analyze in-hospital mortality after pancreatectomy using a large national database. SUMMARY AND BACKGROUND DATA: Pancreatic resections, including pancreaticoduodenectomy, distal pancreatectomy, and total pancreatectomy, remain the only potentially curative interventions for pancreatic cancer. The goal of this study was to define factors affecting outcomes after pancreatectomy for neoplasm. METHODS: A retrospective analysis was performed using all patients undergoing pancreatic resections for neoplastic disease identified from the Nationwide Inpatient Sample from 1998 to 2003. Crude in-hospital mortality was analyzed by chi. A multivariable model was constructed to adjust for age, sex, hospital teaching status, hospital surgical volume, year of resection, payer status, and selected comorbid conditions. RESULTS: In all, 279,445 patient discharges were identified with a primary diagnosis of pancreatic neoplasm. A total of 39,463 (14%) patients underwent resection during that hospitalization. In-hospital mortality was 5.9% with a significant decrease from 7.8% to 4.6% from 1998 to 2003 by trend analysis (P < 0.0001). Resections done at low (<5 procedures/year)- and medium (5-18/year)-volume centers had higher mortality compared with those at high (>18/year)-volume centers (low-volume odds ratio = 3.3; 95% confidence interval, 2.3-4.; medium-volume, odds ratio = 2.1; 95% confidence interval, 1.5-3.0). The proportion of procedures performed at high volume centers increased from 30% to 39% over the 6-year time period (P < 0.0001) by trend test. CONCLUSIONS: This large observational study demonstrates an improvement in operative mortality for patients undergoing pancreatectomy for neoplastic disease from 1998 to 2003. In addition, a greater proportion of pancreatectomies were performed at high-volume centers in 2003. The regionalization of pancreatic surgery may have partially contributed to the observed decrease in mortality rates.
Authors: John D Birkmeyer; Andrea E Siewers; Emily V A Finlayson; Therese A Stukel; F Lee Lucas; Ida Batista; H Gilbert Welch; David E Wennberg Journal: N Engl J Med Date: 2002-04-11 Impact factor: 91.245
Authors: Ahmedin Jemal; Taylor Murray; Elizabeth Ward; Alicia Samuels; Ram C Tiwari; Asma Ghafoor; Eric J Feuer; Michael J Thun Journal: CA Cancer J Clin Date: 2005 Jan-Feb Impact factor: 508.702
Authors: G A Porter; P W Pisters; C Mansyur; A Bisanz; K Reyna; P Stanford; J E Lee; D B Evans Journal: Ann Surg Oncol Date: 2000-08 Impact factor: 5.344
Authors: R H Janes; J E Niederhuber; J S Chmiel; D P Winchester; K C Ocwieja; J H Karnell; R E Clive; H R Menck Journal: Ann Surg Date: 1996-03 Impact factor: 12.969
Authors: Roberto Ballarin; Mario Spaggiari; Nicola Cautero; Nicola De Ruvo; Roberto Montalti; Cristina Longo; Anna Pecchi; Patrizia Giacobazzi; Giuseppina De Marco; Giuseppe D'Amico; Giorgio Enrico Gerunda; Fabrizio Di Benedetto Journal: World J Gastroenterol Date: 2011-11-21 Impact factor: 5.742
Authors: Quoc-Dien Trinh; Jesse Sammon; Jay Jhaveri; Maxine Sun; Khurshid R Ghani; Jan Schmitges; Wooju Jeong; James O Peabody; Pierre I Karakiewicz; Mani Menon Journal: Ther Adv Urol Date: 2012-04
Authors: Purvi Parikh; Mira Shiloach; Mark E Cohen; Karl Y Bilimoria; Clifford Y Ko; Bruce L Hall; Henry A Pitt Journal: HPB (Oxford) Date: 2010-09 Impact factor: 3.647
Authors: James Edward Carroll; Jillian K Smith; Jessica P Simons; Melissa M Murphy; Sing Chau Ng; Shimul A Shah; Zheng Zhou; Jennifer F Tseng Journal: J Gastrointest Surg Date: 2010-09-16 Impact factor: 3.452
Authors: Paul D Colavita; Victor B Tsirline; Igor Belyansky; Ryan Z Swan; Amanda L Walters; Amy E Lincourt; David A Iannitti; B Todd Heniford Journal: J Gastrointest Surg Date: 2014-01-16 Impact factor: 3.452