Impact of surgical volume on nationwide hospital mortality after pancreaticoduodenectomy

Kim, Chul-Gyu; Jo, Seong Mu; Kim, Jae Sun

doi:10.3748/wjg.v18.i31.4175

Cited by 36 publications

(39 citation statements)

References 34 publications

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“…22 While mortality associated with these complex HPB procedures was considerable in the past, more recently, the incidence of in-patient peri-operative death following HPB surgery has been reported to be less than 3–5 %. 18,23,24 Morbidity, however, remains a considerable concern as up to 20–50 % of patients may experience some type of complication following HPB surgery. 12,14,25 In turn, in-patient complications can lead to a prolonged hospital LOS and subsequent increased risk of readmission.…”

Section: Discussionmentioning

confidence: 99%

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

Hyder

Sachs

Ejaz

et al. 2013

Journal of Gastrointestinal Surgery

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Objective To define the impact of hospital teaching status on length of stay and mortality for patients undergoing complex hepatopancreaticobiliary (HPB) surgery in the USA. Methods Using the Nationwide Inpatient Sample, we identified 285,442 patient records that involved a liver resection, pancreatoduodenectomy, other pancreatic resection, or hepaticojejunostomy between years 2000 and 2010. Year-wise distribution of procedures at teaching and non-teaching hospitals was described. The impact of teaching status on in-hospital mortality for operations performed at hospitals in the top tertile of procedure volume was determined using multivariate logistic regression analysis. Results A majority of patients were under 65 years of age (59.6 %), white (74.0 %), admitted on an elective basis (77.3 %), and had a low comorbidity burden (70.5 %). Ninety percent were operated upon at hospitals in the top tertile of yearly procedure volume. Among patients undergoing an operation at a hospital in the top tertile of procedure volume (>25/year), non-teaching status was associated with an increased risk of in-hospital death (OR 1.47 [1.3, 1.7]). Other factors associated with increased risk of mortality were older patient age (OR 2.52 [2.3, 2.8]), male gender (OR 1.73 [1.6, 1.9]), higher comorbidity burden (OR 1.49 [1.3, 1.7]), non-elective admission (OR 3.32 [2.9, 4.0]), and having a complication during in-hospital stay (OR 2.53 [2.2, 3.0]), while individuals with private insurance had a lower risk of in-hospital mortality (OR 0.45 [0.4, 0.5]). After controlling for other covariates, undergoing complex HPB surgery at a non-teaching hospital remained independently associated with 32% increased odds of death as (OR 1.32, 95 % CI 1.11–1.58; P <0.001). Conclusions Even among high-volume hospitals, patients undergoing complex HPB have better outcomes at teaching vs. non-teaching hospitals. While procedural volume is an established factor associated with surgical outcomes among patients undergoing complex HPB procedures, other hospital-level factors such as teaching status have an important impact on peri-operative outcomes.

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Section: Discussionmentioning

confidence: 99%

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

Hyder

Sachs

Ejaz

et al. 2013

Journal of Gastrointestinal Surgery

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“…Pancreatoduodenectomy is one of the most complex procedures in gastroenterological surgery. According to studies involving more than 1000 patients and published after 2000, the perioperative mortality rate is 2·1–3·8 per cent and the postoperative morbidity rate is 31·8–40·0 per cent for pancreatoduodenectomy. Of the many complications following pancreatoduodenectomy, postoperative pancreatic fistula (POPF) is the most important because it can lead to sepsis with fatal outcome.…”

Section: Introductionmentioning

confidence: 99%

Randomized clinical trial of duct-to-mucosa versus invagination pancreaticojejunostomy after pancreatoduodenectomy

Senda

Shimizu

Natsume

et al. 2017

British Journal of Surgery

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Background:The postoperative pancreatic fistula (POPF) rate for duct-to-mucosa and invagination anastomosis after pancreatoduodenectomy is still debated. The aim of this RCT was to investigate the POPF rate for duct-to-mucosa versus invagination pancreaticojejunostomy.Methods: Patients were stratified by pancreatic texture and diameter of the main pancreatic duct and randomized to the duct-to-mucosa or invagination group. The primary endpoint was the rate of clinically relevant POPF (defined as grade B or C). Secondary endpoints were suture material cost for pancreaticojejunostomy, drain insertion duration and duration of postoperative hospital stay.Results: Some 120 patients undergoing pancreatoduodenectomy were included following consent. Clinically relevant POPF developed in six of 59 patients (10 per cent) in the invagination group and in 14 of 61 patients (23 per cent) in the duct-to-mucosa group (P = 0⋅077). Duration of drain insertion (6 versus 7 days respectively; P = 0⋅027) and postoperative hospital stay (19 versus 24 days; P = 0⋅015) were shorter in the invagination group. Subgroup analysis for 61 patients with a soft pancreas revealed a lower rate of clinically relevant POPF in the invagination group (10 per cent versus 42 per cent in the duct-to-mucosa group; P = 0⋅010). Among 20 patients with a clinically relevant POPF, the six patients in the invagination group had a shorter duration of drain insertion (38⋅5 days versus 49 days for 14 patients in the duct-to-mucosa group; P = 0⋅028) and postoperative hospital stay (42 versus 54⋅5 days respectively; P = 0⋅028). Conclusion:This study did not demonstrate a superiority of invagination over duct-to-mucosa pancreaticojejunostomy in the risk of POPF. However, in high-risk patients with a soft pancreas, invagination may reduce the risk of clinically relevant POPF compared with duct-to-mucosa. Registration number: UMIN000005890 (http://www.umin.ac.jp).

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“…Pancreaticoduodenectomy (PD) is a standard surgical treatment for patients with malignant or benign disease of the pancreatic head and the periampullary region. There has been an obvious decline in perimortality rates (to <5%) after PD carried out at high‐volume institutions and PD may perhaps represent the most striking accomplishment in pancreatic surgery to date . However, rates of surgical morbidity lie at 40–50% in many large specialized centres .…”

Section: Introductionmentioning

confidence: 99%

“…There has been an obvious decline in perimortality rates (to <5%) after PD carried out at high-volume institutions and PD may perhaps represent the most striking accomplishment in pancreatic surgery to date. 1,2 However, rates of surgical morbidity lie at 40-50% in many large specialized centres. [3][4][5] The development of a postoperative pancreatic fistula remains the main factor influencing morbidity and even mortality.…”

Section: Introductionmentioning

confidence: 99%

Pancreaticogastrostomy is associated with significantly less pancreatic fistula than pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: a meta‐analysis of seven randomized controlled trials

Liu

Chen

Geng

et al. 2015

HPB

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Impact of surgical volume on nationwide hospital mortality after pancreaticoduodenectomy

Abstract: The higher-volume hospitals showed lower hospital mortality than the lower-volume hospitals after PD in South Korea, which were clarified through the nationwide database.

Cited by 36 publications

References 34 publications

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

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

Randomized clinical trial of duct-to-mucosa versus invagination pancreaticojejunostomy after pancreatoduodenectomy

Pancreaticogastrostomy is associated with significantly less pancreatic fistula than pancreaticojejunostomy reconstruction after pancreaticoduodenectomy: a meta‐analysis of seven randomized controlled trials

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