Impact of Hospital Teaching Status on Length of Stay and Mortality Among Patients Undergoing Complex Hepatopancreaticobiliary Surgery in the USA

Hyder, Omar; Sachs, Teviah E.; Ejaz, Aslam; Spolverato, Gaya; Pawlik, Timothy M.

doi:10.1007/s11605-013-2349-4

Cited by 56 publications

(29 citation statements)

References 31 publications

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“…10,11 In fact, recent studies show that the majority of pancreatic and hepatic resections performed in the United States are in fact performed at teaching hospitals. 12 As such, investigation into the impact of resident participation during liver and pancreatic resections is pertinent and necessary. Using the ACS NSQIP database, we found that although both liver and pancreas resections with resident participants resulted in a longer operative time, perioperative major morbidity was unaffected.…”

Section: Discussionmentioning

confidence: 99%

The impact of resident involvement on surgical outcomes among patients undergoing hepatic and pancreatic resections

Ejaz¹,

Spolverato²,

Kim³

et al. 2015

Surgery

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Background Resident participation during hepatic and pancreatic resections varies. The impact of resident participation on surgical outcomes in hepatic and pancreatic operations is poorly defined. Methods We identified 25,511 patients undergoing a hepatic or pancreatic resection between 2006 and 2012 using the American College of Surgeons National Surgical Quality Improvement Program database. Multivariate regression models were constructed to determine any association between resident participation and surgical outcomes. Results Pancreatic resections (n = 16,045; 62.9%) were more common than liver resections (n = 9,466; 37%). Residents participated in the majority of cases (n = 21,857; 86%), with most involvement at the senior level (postgraduate year ≥ 3, n = 21,147; 97%). Resident participation resulted in slightly longer mean operative times (hepatic, 9 minutes; pancreatic, 22 minutes; both P < .01). Need for perioperative transfusion, hospital duration of stay, and reoperation rates were unaffected by resident participation (all P > .05). Resident participation resulted in a higher risk of overall morbidity (odds ratio [OR], 1.14; 95% CI, 1.05–1.24; P = .001), but not major morbidity (OR, 1.05; 95% CI, 0.93–1.20; P = .40) after liver and pancreas resection. Resident participation resulted in lower odds of 30-day mortality after liver and pancreas resections (OR, 0.75; 95% CI, 0.60–0.94; P = .01). Conclusion Although resident participation resulted in slightly longer operative times and a modest increase in overall complications after liver and pancreatic resection, other metrics such as duration of stay, major morbidity, and mortality were unaffected. These data have important implications for educating patients regarding resident participation in these complex cases.

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Section: Discussionmentioning

confidence: 99%

The impact of resident involvement on surgical outcomes among patients undergoing hepatic and pancreatic resections

Ejaz¹,

Spolverato²,

Kim³

et al. 2015

Surgery

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“…Previous work from our group and others have demonstrated that high‐volume centers, especially centers with a teaching designation, have improved outcomes associated with high‐risk surgical procedures . For example, Hyder et al noted that quality metrics such as length‐of‐stay and mortality following complex hepatopancreaticobiliary surgery were also better at high‐volume academic medical centers. Our group has previously characterized the association between travel distance and hospital volume relative to outcomes following resection of cholangiocarcinoma, gallbladder cancer, and hepatocellular carcinoma .…”

Section: Discussionmentioning

confidence: 92%

“…Previous work from our group and others have demonstrated that high-volume centers, especially centers with a teaching designation, have improved outcomes associated with high-risk surgical procedures. 33 For example, Hyder et al 34 noted that quality metrics such as lengthof-stay and mortality following complex hepatopancreaticobiliary surgery were also better at high-volume academic medical centers.…”

Section: Discussionmentioning

confidence: 99%

Accessing surgical care for pancreaticoduodenectomy: Patient variation in travel distance and choice to bypass hospitals to reach higher volume centers

Díaz

Burns

Paredes

2019

Journal of Surgical Oncology

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Background While better outcomes at high‐volume surgical centers have driven regionalization of complex surgical care, access to high‐volume centers often requires travel over longer distances. We sought to evaluate travel patterns of patients undergoing pancreaticoduodenectomy (PD) for pancreatic cancer to assess willingness of patients to travel for surgical care. Methods The California Office of Statewide Health Planning database was used to identify patients who underwent PD between 2005 and 2016. Total distance traveled, as well as whether a patient bypassed the nearest hospital that performed PD to get to a higher‐volume center was assessed. Multivariate analyses were used to identify factors associated with bypassing a local hospital for a higher‐volume center. Results Among 23 014 patients who underwent PD, individuals traveled a median distance of 18.0 miles to get to a hospital that performed PD. The overwhelming majority (84%) of patients bypassed the nearest providing hospital and traveled a median additional 16.6 miles to their destination hospital. Among patients who bypassed the nearest hospital, 13,269 (68.6%) did so for a high‐volume destination hospital. Specifically, average annual PD volume at the nearest “bypassed” vs final destination hospital was 29.6 vs 56 cases, respectively. Outcomes at bypassed vs destination hospitals varied (incidence of complications: 39.2% vs 32.4%; failure‐to‐rescue: 14.5% vs 9.1%). PD at a high‐volume center was associated with lower mortality (OR = 0.46 95% CI, 0.22‐0.95). High‐volume PD ( > 20 cases) was predictive of hospital bypass (OR = 3.8 95% CI, 3.3‐4.4). Among patients who had surgery at a low‐volume center, nearly 20% bypassed a high‐volume hospital in route. Furthermore, among patients who did not bypass a high‐volume hospital, one‐third would have needed to travel only an additional 30 miles or less to reach the nearest high‐volume hospital. Conclusion Most patients undergoing PD bypassed the nearest providing hospital to seek care at a higher‐volume hospital. While these data reflect increased regionalization of complex surgical care, nearly 1 in 5 patients still underwent PD at a low‐volume center.

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“…No previous study has addressed the association between hospital teaching status and mortality after pancreatic resection. With reference to the association between hospital teaching status and short‐term mortality, two studies from the USA assessed the association between hospital teaching status and in‐hospital mortality after pancreatic and hepatopancreatobiliary resection. The first did not show an association between hospital teaching status and in‐hospital mortality after adjustment for hospital volume.…”

Section: Discussionmentioning

confidence: 99%

“…The first did not show an association between hospital teaching status and in‐hospital mortality after adjustment for hospital volume. The second study included only hospitals in the highest‐volume tertile (over 25 hepatopancreatobiliary resections per year) and showed an increased risk of in‐hospital death in non‐teaching hospitals compared with teaching hospitals. The present study showed no association between hospital teaching status and short‐term mortality.…”

Section: Discussionmentioning

confidence: 99%

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

Derogar

Blomberg

Sadr–Azodi

2015

British Journal of Surgery

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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.

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Impact of Hospital Teaching Status on Length of Stay and Mortality Among Patients Undergoing Complex Hepatopancreaticobiliary Surgery in the USA

Cited by 56 publications

References 31 publications

The impact of resident involvement on surgical outcomes among patients undergoing hepatic and pancreatic resections

The impact of resident involvement on surgical outcomes among patients undergoing hepatic and pancreatic resections

Accessing surgical care for pancreaticoduodenectomy: Patient variation in travel distance and choice to bypass hospitals to reach higher volume centers

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

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