Roheena Z Panni1, Usman Y Panni2, Jingxia Liu3, Gregory A Williams2, Ryan C Fields4, Dominic E Sanford2, William G Hawkins2, Chet W Hammill2. 1. Department of Surgery, Washington University in Saint Louis, USA. Electronic address: roheenazpanni@wustl.edu. 2. Department of Surgery, Washington University in Saint Louis, USA; Division of Hepatobiliary & Pancreatic Surgery, Washington University in Saint Louis, USA. 3. Department of Surgery, Washington University in Saint Louis, USA; Division of Public Health Sciences, Washington University in Saint Louis, USA. 4. Department of Surgery, Washington University in Saint Louis, USA; Division of Surgical Oncology, Washington University in Saint Louis, USA.
Abstract
BACKGROUND: The purpose of this study was to re-evaluate the previously utilized definitions of high volume center for pancreaticoduodenectomy to determine/establish an objective, evidence based threshold of hospital volume associated with improvement in perioperative mortality. METHODS: Patients who underwent pancreaticoduodenectomy were identified using the National Cancer Database from 2004 to 2015. The relationship between hospital volume and 90-day mortality was assessed using a logistic regression model. Receiver Operator Characteristic analysis was performed and Youden's statistic was utilized to calculate the optimal cut offs. RESULTS: 42,402 patients underwent elective Pancreaticoduodenectomy at 1238 unique hospitals. A logistic regression was performed which showed a significant inverse linear association between institutional volume and overall 90 day mortality. The maximum improvement in 90 day mortality is seen if the average annual hospital volume was greater than 9 (OR = 0.647 (0.595-0.702), p < 0.0001). When analysis is limited to hospitals that performed >9 cases per year, the maximum improvement in 90 day mortality was noticed at 36 cases per year (OR = 0.458 (0.399-0.525), p < 0.0001). CONCLUSIONS: Based on our results, we recommend defining low, medium, and high volume centers for pancreaticoduodenectomy as hospitals with average annual volume less than 9, 9 to 35, and more than 35 cases per year, respectively.
BACKGROUND: The purpose of this study was to re-evaluate the previously utilized definitions of high volume center for pancreaticoduodenectomy to determine/establish an objective, evidence based threshold of hospital volume associated with improvement in perioperative mortality. METHODS: Patients who underwent pancreaticoduodenectomy were identified using the National Cancer Database from 2004 to 2015. The relationship between hospital volume and 90-day mortality was assessed using a logistic regression model. Receiver Operator Characteristic analysis was performed and Youden's statistic was utilized to calculate the optimal cut offs. RESULTS: 42,402 patients underwent elective Pancreaticoduodenectomy at 1238 unique hospitals. A logistic regression was performed which showed a significant inverse linear association between institutional volume and overall 90 day mortality. The maximum improvement in 90 day mortality is seen if the average annual hospital volume was greater than 9 (OR = 0.647 (0.595-0.702), p < 0.0001). When analysis is limited to hospitals that performed >9 cases per year, the maximum improvement in 90 day mortality was noticed at 36 cases per year (OR = 0.458 (0.399-0.525), p < 0.0001). CONCLUSIONS: Based on our results, we recommend defining low, medium, and high volume centers for pancreaticoduodenectomy as hospitals with average annual volume less than 9, 9 to 35, and more than 35 cases per year, respectively.
Authors: Antonio Giuliani; Pasquale Avella; Anna Lucia Segreto; Maria Lucia Izzo; Antonio Buondonno; Mariagrazia Coluzzi; Micaela Cappuccio; Maria Chiara Brunese; Roberto Vaschetti; Andrea Scacchi; Germano Guerra; Bruno Amato; Fulvio Calise; Aldo Rocca Journal: Front Surg Date: 2021-12-21
Authors: Rony Takchi; Heidy Cos; Gregory A Williams; Cheryl Woolsey; Chet W Hammill; Ryan C Fields; Steven M Strasberg; William G Hawkins; Dominic E Sanford Journal: HPB (Oxford) Date: 2021-06-16 Impact factor: 3.842