Ann Falor Callahan1, Philip H G Ituarte2, Leanne Goldstein2, Susanne G Warner1, Yanghee Woo1, Gagandeep Singh1, Yuman Fong1, Laleh G Melstrom3. 1. Department of Surgical Oncology, City of Hope National Medical Center, 1500 E Duarte Rd., Duarte, CA, 91010, USA. 2. Department of Biostatistics, City of Hope National Medical Center, Duarte, CA, USA. 3. Department of Surgical Oncology, City of Hope National Medical Center, 1500 E Duarte Rd., Duarte, CA, 91010, USA. lmelstrom@coh.org.
Abstract
BACKGROUND: Pancreatectomy for malignancy is associated with improved outcomes when performed at high-volume centers. The goal of this study was to assess pancreatectomy outcomes for premalignant cystic lesions as a function of hospital volume. METHODS: The Healthcare Cost and Utilization Project (HCUP) was queried for all pancreatectomies performed in California from 2003 to 2011. Cases were stratified, separating benign versus malignant disease. Hospitals were categorized as low-volume (≤25 pancreatectomies/year; LV) or high-volume (>25; HV) centers. Perioperative morbidity, mortality, and length of stay were compared in HV vs. LV centers. RESULTS: There were 7554 pancreatectomies performed in 201 hospitals during the study period, where 5652 (75%) procedures were performed for malignancy, 338 (4%) for chronic pancreatitis, and 1564 (21%) for benign/premalignant cysts. The majority of pancreatectomies for cystic disease were performed at LV centers (65%). There were no significant differences in length of stay (7 vs. 8 days; p = 0.6) or 90-day readmission rates (12.8% vs. 12.9%; p = 1.0) in HV versus LV centers. However, there were higher surgical (46.2% LV vs. 41.1% HV, p = 0.05) and medical (13.3% LV vs. 9.2% HV; p = 0.017) complications at LV centers. Most importantly, there was a fourfold higher in-hospital mortality at LV centers (2.36% vs. 0.55%; p = 0.007). CONCLUSION: Pancreatic resection for benign lesions at HV hospitals is associated with significantly lower morbidity and mortality, suggesting that when feasible, patients should seek care at high-volume centers for these semi-elective surgeries.
BACKGROUND: Pancreatectomy for malignancy is associated with improved outcomes when performed at high-volume centers. The goal of this study was to assess pancreatectomy outcomes for premalignant cystic lesions as a function of hospital volume. METHODS: The Healthcare Cost and Utilization Project (HCUP) was queried for all pancreatectomies performed in California from 2003 to 2011. Cases were stratified, separating benign versus malignant disease. Hospitals were categorized as low-volume (≤25 pancreatectomies/year; LV) or high-volume (>25; HV) centers. Perioperative morbidity, mortality, and length of stay were compared in HV vs. LV centers. RESULTS: There were 7554 pancreatectomies performed in 201 hospitals during the study period, where 5652 (75%) procedures were performed for malignancy, 338 (4%) for chronic pancreatitis, and 1564 (21%) for benign/premalignant cysts. The majority of pancreatectomies for cystic disease were performed at LV centers (65%). There were no significant differences in length of stay (7 vs. 8 days; p = 0.6) or 90-day readmission rates (12.8% vs. 12.9%; p = 1.0) in HV versus LV centers. However, there were higher surgical (46.2% LV vs. 41.1% HV, p = 0.05) and medical (13.3% LV vs. 9.2% HV; p = 0.017) complications at LV centers. Most importantly, there was a fourfold higher in-hospital mortality at LV centers (2.36% vs. 0.55%; p = 0.007). CONCLUSION: Pancreatic resection for benign lesions at HV hospitals is associated with significantly lower morbidity and mortality, suggesting that when feasible, patients should seek care at high-volume centers for these semi-elective surgeries.
Authors: S F Khuri; J Daley; W Henderson; K Hur; M Hossain; D Soybel; K W Kizer; J B Aust; R H Bell; V Chong; J Demakis; P J Fabri; J O Gibbs; F Grover; K Hammermeister; G McDonald; E Passaro; L Phillips; F Scamman; J Spencer; J F Stremple Journal: Ann Surg Date: 1999-09 Impact factor: 12.969
Authors: Bellal Joseph; John M Morton; Tina Hernandez-Boussard; Ilan Rubinfeld; Chadi Faraj; Vic Velanovich Journal: J Am Coll Surg Date: 2009-04 Impact factor: 6.113
Authors: Timothy E Newhook; Damien J LaPar; James M Lindberg; Todd W Bauer; Reid B Adams; Victor M Zaydfudim Journal: J Gastrointest Surg Date: 2015-03-24 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