Pancreatic Resection Results in a Statewide Surgical Collaborative

Abstract

Background A strong relationship between hospital caseload and adverse outcomes has been demonstrated for pancreatic resections. Participation in regional surgical collaboratives may mitigate this phenomenon. This study sought to investigate changes over time in adverse outcomes after pancreatectomy across hospitals with different caseloads in a statewide surgical collaborative. Methods The study investigated patients undergoing pancreatic resection from January 2008 to August 2013 at Michigan Surgical Quality Collaborative (MSQC) hospitals (1007 patients in 19 academic and community hospitals). Risk-adjusted rates of major complications, mortality, and failure to rescue were compared between hospitals based on caseloads (low, medium, and high) in early (2008–2010) and later (2011–2013) periods. Finally, the degree to which different complications explained changes in hospital outcome variation was assessed. Results Adjusted rates of major complications and mortality decreased over time, driven largely by improvements at low-caseload hospitals. In 2008–2010, risk-adjusted major complication rates were higher for low-caseload than for high-caseload hospitals (27.8 vs. 17.8 %; p = 0.02). However, these differences were attenuated in 2011–2013 (22.2 vs. 20.0 %; p = 0.74). Similarly, adjusted mortality rates were higher in low-caseload hospitals in 2008–2010 (6.2 vs. 0.8 %; p = 0.02), but these differences were attenuated in 2011–2013 (3.3 vs. 1.1 %; p = 0.18). Variation in major complications decreased, largely due to decreased variation in “medical” complication rates, with less change in surgical-site complications. Conclusion Participation in regional quality collaboratives by lower-volume hospitals can attenuate the volume–outcome relationship for pancreatic surgery. Continued work in collaboratives with an emphasis on technical and intraoperative aspects of care may improve overall quality of care.

Potential impact of a volume pledge on spatial access: A population-level analysis of patients undergoing pancreatectomy

“…Instead, participation of low-volume centers in Statewide or Regional Quality Collaboratives can help drive improvements through sharing expertise and conducting joint multidisciplinary evaluation of patients. 32, 33 Additionally, identifying care processes beyond volume may help inform and focus quality improvement initiatives at hospitals of any volume. 34, 35 …”

Effects of patient factors on inpatient mortality after complex liver, pancreatic and gastric resections

“…The present finding that there is no statistically significant relationship between hospital case volume and mortality risk in the current era may indicate that these efforts have been successful. Recent investigations34 35 suggest that observed improvements over time in patient‐specific outcomes after pancreatic resection are associated with both patient migration to higher‐volume centres and reduced overall morbidity and mortality in lower‐volume centres.…”

Pancreatic Resection Results in a Statewide Surgical Collaborative

“…Also, only 82 % were willing to travel if told that their mortality risk was sixfold higher at their local facility. 4 Even across high-volume centers, there is significant variability in outcomes.5 Given the wide variability in outcomes and the challenges and reality of regionalization, it is critical to explore alternative approaches to improving overall outcomes as well as closing the ''quality gap'' observed between high-and low-volume providers.Healy et al 6 provide data to suggest that participation in a regional quality improvement collaborative may provide an alternative model to improving outcomes for patients undergoing pancreatic resection. Leveraging data from an already existing statewide surgical quality collaborative, the authors demonstrate improvement in risk-adjusted morbidity, mortality, and failure to rescue rates for pancreatectomy between two time periods, 2008-2010 and 2011-2013.…”

“…Healy et al 6 provide data to suggest that participation in a regional quality improvement collaborative may provide an alternative model to improving outcomes for patients undergoing pancreatic resection. Leveraging data from an already existing statewide surgical quality collaborative, the authors demonstrate improvement in risk-adjusted morbidity, mortality, and failure to rescue rates for pancreatectomy between two time periods, 2008-2010 and 2011-2013.…”

“…A general quality collaborative, such as that described by Healy et al, 6 may be most beneficial for addressing broader process measures and complications. These items could include appropriate antibiotic use, prevention of ventilator-associated pneumonia, implementation of enhanced recovery protocols to be used after surgery, and avoiding inappropriate blood transfusions.…”