Mo1512 Pancreaticoduodenectomy at High Volume Centers-Surgeon Volume Goes Beyond the Leapfrog Criteria

Mathur, Abhishek; Luberice, Kenneth; Choung, Edward; Ross, Sharona; Rosemurgy, Alexander S.

doi:10.1016/s0016-5085(12)64202-4

Cited by 11 publications

(20 citation statements)

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“…While some studies have indicated that better surgical outcomes are more correlated with center volume than with the specific surgeon [2], others have reported that surgeon volume is a key factor [3], with a high-volume surgeon relocated to a low-volume center able to achieve the same results as previously achieved in a high-volume setting [4]. It has also been shown that low-volume surgeons performing pancreatic procedures achieve comparable postoperative morbidity in both high-and low-volume centers, although other outcomes less directly related to surgeon volume may be improved in a high-volume setting, for example, shorter hospital length of stay [5]. It has also not yet been assessed if the volumeoutcome relationship relates only to pancreatic surgery procedures or if the overall surgical volume of the center plays a role.…”

Section: Introductionmentioning

confidence: 68%

Management and Outcomes of Pancreatic Resections Performed in High-Volume Referral and Low-Volume Community Hospitals Lead by Surgeons Who Shared the Same Mentor: The Importance of Training

Capretti

Balzano

Gianotti³

et al. 2017

Dig Surg

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Background: High hospital volume improves outcomes after pancreatic resection. The aim of this study was to assess if practice and outcomes differed between high- and low-volume centers across which chief surgeons shared a similar training and mentoring. Methods: Data on patients undergoing standard pancreatic resections (2010-2013) at 7 Italian hospitals were collected. Chiefs of pancreatic surgery at each hospital had received the same training, with the same mentor. Two centers were high-volume referral hospitals for pancreatic disease, while 5 were low-volume hospitals. Results: A total of 856 patients were included, with median annual volume of resections 82 at high-volume referral hospitals and 11 at low-volume hospitals. Patients at low-volume hospitals were older, had more comorbidities, and were more often referred from the emergency room. Intraoperative techniques and reconstruction methods were similar. Comparable rates of major postoperative complications (18 vs. 22%; p = 0.236) and pancreatic fistula (29 vs. 32%; p = 0.287) were achieved in both groups, with no significant increases in failure to rescue from grade B-C fistula (6.2 vs. 15.0%; p = 0.108) and mortality (2.4 vs. 4.1%; p = 0.233) in low-volume hospitals. Postoperative length of stay was shorter in high-volume referral hospitals (10 vs. 15 days; p < 0.001). Conclusion: Similar postoperative outcomes can be achieved across high- and low-volume centers where chief surgeons shared a similar training and mentoring. However, multidisciplinary postoperative provision more often associated with high-volume centers may also affect outcomes.

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Section: Introductionmentioning

confidence: 68%

Management and Outcomes of Pancreatic Resections Performed in High-Volume Referral and Low-Volume Community Hospitals Lead by Surgeons Who Shared the Same Mentor: The Importance of Training

Capretti

Balzano

Gianotti³

et al. 2017

Dig Surg

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“…Surgeon volume has been shown to account for a part of the hospital effect in PD. [26][27][28] A significant proportion of the surgeons who performed the PD in this study's dataset operate in two or more of the hospitals examined. These inter-hospital links commonly extend between a PRH and PGA hospital.…”

Section: Discussionmentioning

confidence: 99%

Short‐term outcomes of pancreaticoduodenectomy in the state of Victoria: hospital resources are more important than volume

Stevens

Watters

2019

ANZ Journal of Surgery

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Background Pancreaticoduodenectomy (PD) is a high‐risk procedure. Australian hospitals perform a relatively low volume of PD. This study sought to gain an understanding of hospital volume and short‐term outcomes of the procedure in the Australian state of Victoria. Methods The Dr Foster Quality Investigator tool was used to interrogate the Victorian Admitted Episodes Database for the Australian Classification of Health Intervention code for PD (30584) from July 2010 to June 2016. The data set included patients from a peer group of 14 hospitals that included all the public hospitals performing PD during this period. Patient characteristics, inpatient mortality, 30‐day readmission rates and median length of stay were reported for each de‐identified hospital. Results There were 547 PD conducted over 6 years in 10 public hospitals. The median patient age was 65 years. Inpatient mortality was 2.7%. There was a significant risk adjusted difference in mortality between principal referral and other public hospitals. Annual hospital volume ranged from 3 to 20 PD, and there was no significant relationship between mortality, readmission rates or length of stay and hospital volume. Conclusion The inpatient mortality associated with PD in Victorian public hospitals is comparable to that seen in overseas studies. While hospital volume is relatively low, there does not seem to be a relationship between volume and short‐term outcomes. Variability between hospital peer groups suggests that resource availability is more important than volume. The development of a procedure specific registry would be useful to test the outcomes of this study and determine long‐term PD outcomes.

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“…High hospital volume is strongly correlated with low mortality rates (17). Furthermore, a high volume surgeon is associated with low mortality rates after pancreatic resections (18,19). In is worth to mention however that even nowadays the mortality after pancreatectomies is not nil, particularly after pancreatico-duodenectomies.…”

Section: Resectable Pdacmentioning

confidence: 99%

Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

Popescu¹,

Dumitraşcu²

2017

SGO

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Pancreatic ductal adenocarcinoma (PDAC) is an important healthcare problem because is a leading cause of death by cancer. PDAC is a highly lethal disease with a very dismal prognosis. Most patients present advanced disease at diagnosis. The management of a patient diagnosed with PDAC should be discussed in a multidisciplinary team in high-volume centers. Pancreatectomy represents the single hope of long-term survival for a patient with PDAC but the resectability rate is less than 20% of the cases. Several progresses were observed in the last years regarding the surgical and oncological approach for PDAC. The aim of the paper is to make a brief review of the current onco-surgical strategies available for patients with PDAC.

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Mo1512 Pancreaticoduodenectomy at High Volume Centers-Surgeon Volume Goes Beyond the Leapfrog Criteria

Cited by 11 publications

References 0 publications

Management and Outcomes of Pancreatic Resections Performed in High-Volume Referral and Low-Volume Community Hospitals Lead by Surgeons Who Shared the Same Mentor: The Importance of Training

Management and Outcomes of Pancreatic Resections Performed in High-Volume Referral and Low-Volume Community Hospitals Lead by Surgeons Who Shared the Same Mentor: The Importance of Training

Short‐term outcomes of pancreaticoduodenectomy in the state of Victoria: hospital resources are more important than volume

Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

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