Terence C Chua1,2, Anubhav Mittal1,2, Chris Nahm1,2, Thomas J Hugh1,2, Jenny Arena1,2, Anthony J Gill3,4,5, Jaswinder S Samra1,2,6. 1. Upper Gastrointestinal Surgical Unit, Royal North Shore Hospital, Sydney, New South Wales, Australia. 2. Discipline of Surgery, The University of Sydney, Sydney, New South Wales, Australia. 3. Cancer Diagnosis and Pathology Group, Kolling Institute of Medical Research, Sydney, New South Wales, Australia. 4. The University of Sydney, Sydney, New South Wales, Australia. 5. Department of Anatomical Pathology, Royal North Shore Hospital, Sydney, New South Wales, Australia. 6. Macquarie University Hospital, Macquarie University, Sydney, New South Wales, Australia.
Abstract
BACKGROUND: The impact of the public and private hospital systems on major abdominal operations that are demanding on clinical resources, such as pancreatic surgery, has not been explored in an Australian setting. This study examines the perioperative outcome of patients undergoing pancreatoduodenectomy (PD) at a major public and private hospital. METHODS: Patients undergoing PD between January 2004 and October 2015 were classified based on their health insurance status and location of where the surgery was performed. Clinical variables relating to perioperative outcome were retrieved and compared using univariate and multivariate analyses. RESULTS: Four hundred and twenty patients underwent PD of whom 232 patients (55%) were operated on in the private hospital. Overall, there was no difference in morbidity and mortality in the public versus the private hospital. However, there were variations in public versus private hospital, this included longer duration of surgery (443 min versus 372 min; P < 0.001), increased estimated blood loss (683 mL versus 506 mL; P < 0.001) and more patients requiring perioperative blood transfusion (25% versus 13%; P = 0.001). Of the 10 complications compared, post-operative bleeding was higher in the private hospital (11% versus 5%; P = 0.051) and intra-abdominal collections were more common in the public hospital (11% versus 5%; P = 0.028). Independent predictive factors for major complications were American Society of Anesthesiologists score (odds ratio (OR) = 1.91; P = 0.050), patients requiring additional visceral resection (OR = 3.36; P = 0.014) and post-operative transfusion (OR = 3.37; P < 0.001). The hospital type (public/private) was not associated with perioperative outcome. CONCLUSION: Comparable perioperative outcomes were observed between patients undergoing PD in a high-volume specialized unit in both the public and private hospital systems.
BACKGROUND: The impact of the public and private hospital systems on major abdominal operations that are demanding on clinical resources, such as pancreatic surgery, has not been explored in an Australian setting. This study examines the perioperative outcome of patients undergoing pancreatoduodenectomy (PD) at a major public and private hospital. METHODS:Patients undergoing PD between January 2004 and October 2015 were classified based on their health insurance status and location of where the surgery was performed. Clinical variables relating to perioperative outcome were retrieved and compared using univariate and multivariate analyses. RESULTS: Four hundred and twenty patients underwent PD of whom 232 patients (55%) were operated on in the private hospital. Overall, there was no difference in morbidity and mortality in the public versus the private hospital. However, there were variations in public versus private hospital, this included longer duration of surgery (443 min versus 372 min; P < 0.001), increased estimated blood loss (683 mL versus 506 mL; P < 0.001) and more patients requiring perioperative blood transfusion (25% versus 13%; P = 0.001). Of the 10 complications compared, post-operative bleeding was higher in the private hospital (11% versus 5%; P = 0.051) and intra-abdominal collections were more common in the public hospital (11% versus 5%; P = 0.028). Independent predictive factors for major complications were American Society of Anesthesiologists score (odds ratio (OR) = 1.91; P = 0.050), patients requiring additional visceral resection (OR = 3.36; P = 0.014) and post-operative transfusion (OR = 3.37; P < 0.001). The hospital type (public/private) was not associated with perioperative outcome. CONCLUSION: Comparable perioperative outcomes were observed between patients undergoing PD in a high-volume specialized unit in both the public and private hospital systems.
Authors: Claudia P Orlas; Juan Pablo Herrera-Escobar; Cheryl K Zogg; José J Serna; Juan J Meléndez; Alexandra Gómez; Diana Martínez; Michael W Parra; Alberto F García; Fernando Rosso; Luis Fernando Pino; Adolfo Gonzalez; Carlos A Ordoñez Journal: World J Surg Date: 2020-06 Impact factor: 3.352
Authors: Ashika D Maharaj; Jennifer F Holland; Ri O Scarborough; Sue M Evans; Liane J Ioannou; Wendy Brown; Daniel G Croagh; Charles H C Pilgrim; James G Kench; Lara R Lipton; Trevor Leong; John J McNeil; Mehrdad Nikfarjam; Ahmad Aly; Paul R Burton; Paul A Cashin; Julie Chu; Cuong P Duong; Peter Evans; David Goldstein; Andrew Haydon; Michael W Hii; Brett P F Knowles; Neil D Merrett; Michael Michael; Rachel E Neale; Jennifer Philip; Ian W T Porter; Marty Smith; John Spillane; Peter P Tagkalidis; John R Zalcberg Journal: BMJ Open Date: 2019-09-30 Impact factor: 2.692