Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy

Birkmeyer, John D.; Finlayson, Samuel R.G.; Tosteson, Anna N.A.; Sharp, Sandra M.; Warshaw, Andrew L.; Fisher, Elliott S.

doi:10.1016/s0039-6060(99)70234-5

Cited by 446 publications

(141 citation statements)

References 21 publications

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“…and retrospectively reviewed. These two units are medium volume for pancreatic surgery [13, 14]. Medium- and long-term follow-up data were obtained through the same medical database.…”

Section: Methodsmentioning

confidence: 99%

Pancreatic stump closure after pancreatoduodenectomy in elderly patients: a retrospective clinical study

et al. 2016

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BackgroundPancreatic fistula (PF) after pancreatoduodenectomy (PD) represents the major source of morbidity. Derivative procedures are preferred by pancreatic surgeons, but the optimal management of remnant pancreatic stump remains controversial.AimsThe purpose of this retrospective study is to evaluate the efficacy and safety of pancreatic stump closure in selected elderly patients (>65 years).MethodsClinical data of 44 PD undergone mechanical closure of the pancreatic stump performed between 2001 and 2014 in two department of general and oncologic surgery were retrospectively collected. Considering the age, patients were divided into two groups: 21 patients of less than 65 years (Group A) and 23 patients of more than 65 years (Group B).ResultsA soft pancreatic parenchyma with a not-dilated duct (diameter <3 mm) was reported in all the 44 patients. A grade-A PF, which did not required further treatments, developed in 20 cases (45.4%; 13 in group A and 7 in group B; p < 0.05), grade-B in 5 patients (11.4%; 3 in group A and 2 in group B; statistically not significant) and a grade-C PF was observed only in one patient (2.2%; 1 in group A and 0 in group B).DiscussionIn selected “high risk” elderly patients (>65 years) with soft pancreatic texture, the closure of the pancreatic stump can be a useful tool in the surgical armamentarium with the aim to reduce the incidence of age-related complications.ConclusionsProspective randomized controlled trial to better evaluate PF risk factors is needed.

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“…and retrospectively reviewed. These two units are medium volume for pancreatic surgery [13, 14]. Medium- and long-term follow-up data were obtained through the same medical database.…”

Section: Methodsmentioning

confidence: 99%

Pancreatic stump closure after pancreatoduodenectomy in elderly patients: a retrospective clinical study

et al. 2016

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“…[40][41][42][43] Perhaps surprisingly, operative mortality did not increase with advancing age in any of these studies although the complication rate in patients aged >80 years was higher than those <80 years in one study (57% v 41%, respectively; p=0.05). 40 Hospital volume has been shown to have a significant effect on total inhospital mortality following pancreatic surgery [44][45][46] and other complex high risk gastrointestinal surgical procedures, 47 although no analysis of the link to fistula formation was made. All of these studies found a significant correlation between high hospital volume and low mortality, although definitions of "high volume" and "low volume" varied considerably.…”

Section: Factors Affecting Mortalitymentioning

confidence: 99%

The relevance of gastrointestinal fistulae in clinical practice: a review

Falconi

Pederzoli

2001

Gut

115

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“…One of the first studies examining the relationship between hospital volume and surgical outcomes was published in 1979 by Luft et al [14]. Since that time, there have been numerous studies published on the association between hospital volume and surgical outcomes for complex, high-risk operations [15][16][17][18][19][20][21]. The overwhelming majority of these studies have demonstrated that high-volume hospitals have improved outcomes, particularly for high-risk operations.…”

Section: Introductionmentioning

confidence: 99%