BACKGROUND: The current recommendation is that pancreatic resections be performed at hospitals doing >10 pancreatic resections annually. OBJECTIVE: To evaluate the extent of regionalization of pancreatic resection and the factors predicting resection at high-volume centers (>10 cases/year) in Texas. METHODS: Using the Texas Hospital Inpatient Discharge Public Use Data File, we evaluated trends in the percentage of patients undergoing pancreatic resection at high-volume centers (>10 cases/year) from 1999 to 2004 and determined the factors that independently predicted resection at high-volume centers. RESULTS: A total of 3,189 pancreatic resections were performed in the state of Texas. The unadjusted in-hospital mortality was higher at low-volume centers (7.4%) compared to high-volume centers (3.0%). Patients resected at high-volume centers increased from 54.5% in 1999 to 63.3% in 2004 (P = 0.0004). This was the result of a decrease in resections performed at centers doing less than five resections/year (35.5% to 26.0%). In a multivariate analysis, patients who were >75 (OR = 0.51), female (OR = 0.86), Hispanic (OR = 0.58), having emergent surgery (OR = 0.39), diagnosed with periampullary cancer (OR = 0.68), and living >75 mi from a high-volume center (OR = 0.93 per 10-mi increase in distance, P < 0.05 for all OR) were less likely to be resected at high-volume centers. The odds of being resected at a high-volume center increased 6% per year. CONCLUSIONS: Whereas regionalization of pancreatic resection at high-volume centers in the state of Texas has improved slightly over time, 37% of patients continue to undergo pancreatic resection at low-volume centers, with more than 25% occurring at centers doing less than five per year. There are obvious demographic disparities in the regionalization of care, but additional unmeasured barriers need to be identified.
BACKGROUND: The current recommendation is that pancreatic resections be performed at hospitals doing >10 pancreatic resections annually. OBJECTIVE: To evaluate the extent of regionalization of pancreatic resection and the factors predicting resection at high-volume centers (>10 cases/year) in Texas. METHODS: Using the Texas Hospital Inpatient Discharge Public Use Data File, we evaluated trends in the percentage of patients undergoing pancreatic resection at high-volume centers (>10 cases/year) from 1999 to 2004 and determined the factors that independently predicted resection at high-volume centers. RESULTS: A total of 3,189 pancreatic resections were performed in the state of Texas. The unadjusted in-hospital mortality was higher at low-volume centers (7.4%) compared to high-volume centers (3.0%). Patients resected at high-volume centers increased from 54.5% in 1999 to 63.3% in 2004 (P = 0.0004). This was the result of a decrease in resections performed at centers doing less than five resections/year (35.5% to 26.0%). In a multivariate analysis, patients who were >75 (OR = 0.51), female (OR = 0.86), Hispanic (OR = 0.58), having emergent surgery (OR = 0.39), diagnosed with periampullary cancer (OR = 0.68), and living >75 mi from a high-volume center (OR = 0.93 per 10-mi increase in distance, P < 0.05 for all OR) were less likely to be resected at high-volume centers. The odds of being resected at a high-volume center increased 6% per year. CONCLUSIONS: Whereas regionalization of pancreatic resection at high-volume centers in the state of Texas has improved slightly over time, 37% of patients continue to undergo pancreatic resection at low-volume centers, with more than 25% occurring at centers doing less than five per year. There are obvious demographic disparities in the regionalization of care, but additional unmeasured barriers need to be identified.
Authors: T A Gordon; H M Bowman; E B Bass; K D Lillemoe; C J Yeo; R F Heitmiller; M A Choti; G P Burleyson; G Hsieh; J L Cameron Journal: J Am Coll Surg Date: 1999-07 Impact factor: 6.113
Authors: N Tjarda van Heek; Koert F D Kuhlmann; Rob J Scholten; Steve M M de Castro; Olivier R C Busch; Thomas M van Gulik; Huug Obertop; Dirk J Gouma Journal: Ann Surg Date: 2005-12 Impact factor: 12.969
Authors: Keith D Lillemoe; John L Cameron; Min P Kim; Kurtis A Campbell; Patricia K Sauter; Joann A Coleman; Charles J Yeo Journal: J Gastrointest Surg Date: 2004-11 Impact factor: 3.452
Authors: J R Lange; S M Steinberg; G M Doherty; H N Langstein; D E White; T H Shawker; R C Eastman; R T Jensen; J A Norton Journal: Surgery Date: 1992-12 Impact factor: 3.982
Authors: Carrie E Ryan; Thomas W Wood; Sharona B Ross; Amanda E Smart; Prashant B Sukharamwala; Alexander S Rosemurgy Journal: HPB (Oxford) Date: 2015-08-07 Impact factor: 3.647
Authors: Elisabeth T Tracy; Kyla M Bennett; Emeline M Aviki; Theodore N Pappas; Bradley H Collins; Janet E Tuttle-Newhall; Carlos E Marroquin; Paul C Kuo; John E Scarborough Journal: HPB (Oxford) Date: 2009-08 Impact factor: 3.647
Authors: Nicholas G Csikesz; Anand Singla; Melissa M Murphy; Jennifer F Tseng; Shimul A Shah Journal: Dig Dis Sci Date: 2009-11-13 Impact factor: 3.199
Authors: Noaman Ali; Colin O'Rourke; Kevin El-Hayek; Sricharan Chalikonda; D Rohan Jeyarajah; R Matthew Walsh Journal: HPB (Oxford) Date: 2014-12-29 Impact factor: 3.647
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
Authors: Deepthi M Reddy; Courtney M Townsend; Yong-Fang Kuo; Jean L Freeman; James S Goodwin; Taylor S Riall Journal: J Gastrointest Surg Date: 2009-09-16 Impact factor: 3.452