Hospital teaching status and volume related to mortality after pancreatic cancer surgery in a national cohort

Abstract

Background:The association between hospital teaching status and mortality after pancreatic resection is not well explored. Although hospital volume is related to short-term mortality, the effect on long-term survival needs investigation, taking into account hospital teaching status and selective referral patterns. Results: A total of 3298 patients were identified during the study interval. Hospital teaching status was associated with a decrease in overall mortality during the latest interval (years 2005-2010) (university versus non-university hospitals: HR 0⋅72, 95 per cent c.i. 0⋅56 to 0⋅91; P = 0⋅007). During all time periods, hospital teaching status was associated with decreased mortality more than 2 years after surgery (university versus non-university hospitals: HR 0⋅86, 0⋅75 to 0⋅98; P = 0⋅026). Lower annual hospital volume increased the risk of short-term mortality (HR for 3 or fewer compared with 4-6 pancreatic cancer resections annually: 1⋅60, 1⋅04 to 2⋅48; P = 0⋅034), but not long-term mortality. Sensitivity analyses with adjustment for tumour stage did not change the results. Conclusion:Hospital teaching status was strongly related to decreased mortality in both the short and long term. This may relate to processes of care rather than volume per se. Very low-volume hospitals had the highest short-term mortality risk.

Centralization of Pancreatic Surgery Improves Results: Review

“…Westgaard et al (5) showed that 5-year survival among PDAC patients undergoing PD may be higher in HVCs than in LVCs, 26% versus 13%. However, Waterhouse et al (36) with data on 270 and Derogar et al (35) with data on 3298 PRs found no association between hospital volume and long-term survival in their survival analyses. Waterhouse et al (36) reported that patients operated on by surgeons performing fewer than four PRs per year had higher mortality rates and lower survival rates up to 1.5 years after surgery.…”

Risk factors and preventive strategies for post-operative pancreatic fistula after pancreatic surgery: a comprehensive review

“…Pancreatic surgery is now performed with better safety and lower mortality compared to the past. [ 1 , 2 ] Still, post-operative morbidity remains a challenge and occurs in up to 40–50% of patient, even in modern series. [ 3–5 ] Although complication patterns after pancreas surgery differ with type and indication, the most frequent complications reported after a pancreatiocoduodenectomy are delayed gastric emptying, post-operative hemorrhage and post-operative pancreatic fistulas (POPF).…”

Autologous Islet Transplantation in Patients Requiring Pancreatectomy: A Broader Spectrum of Indications Beyond Chronic Pancreatitis

“…Pancreatic surgery is a technically demanding major procedure burdened by a significant rate of complications , including death . In the past decades, consolidation of surgical expertise, centralization of pancreatic surgery in high‐volume centers, and overall improvement of medical support of surgical patients have resulted in a steep decline of pancreatic surgery mortality from ~25% during the 1960s to the current rate of <5% . As the survival of patients after pancreatic surgery has increased , attention has broadened to include patients’ quality of life .…”