Relation of Perioperative Deaths to Hospital Volume Among Patients Undergoing Pancreatic Resection for Malignancy

Lieberman, Michael D.; Kilburn, Harold; Lindsey, Michael; Brennan, Murray F.

doi:10.1097/00000658-199311000-00006

Cited by 123 publications

(180 citation statements)

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“…These results were confirmed later in a second review with 1972 patients who had undergone pancreaticoduodenectomy in New York State between 1984 and 1991 [11]. The perioperative mortality was 15.5% for low-volume surgeons compared with 4.7% for high-volume pancreatic surgeons [11]. Logistic regression analysis demonstrated that perioperative death was significantly related to hospital volume, but the surgeon's experience was not significantly related to perioperative deaths when hospital volume was controlled.…”

Section: Discussionmentioning

confidence: 74%

“…The hospital mortality rate approached 30% for less experienced hospitals and surgeons compared with less than 5% for the most active hospitals [26]. These results were confirmed later in a second review with 1972 patients who had undergone pancreaticoduodenectomy in New York State between 1984 and 1991 [11]. The perioperative mortality was 15.5% for low-volume surgeons compared with 4.7% for high-volume pancreatic surgeons [11].…”

Section: Discussionmentioning

confidence: 79%

“…Neither intraoperative nor postoperative complications occurred with a significantly greater incidence in older patients. Without adequate patient selection, mortality increases significantly from 6.1% of patients younger than 50 years to 16.6% of patients older than 70 years [11].…”

Section: Discussionmentioning

confidence: 99%

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Factors Influencing Morbidity and Mortality after Pancreaticoduodenectomy: Critical Analysis of 221 Resections

1999

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A critical analysis of morbidity and mortality for pancreatico-duodenectomy was performed on 221 patients. During the 1960s and 1970s, the morbidity and mortality for pancreaticoduodenectomy were so high that many thought the operative procedure ought to be abandoned. During the 1980s, however, many centers reported mortality rates around 5% and a morbidity of 25% to 35%. Others still reported a mortality of more than 10% and a morbidity of up to 65%. The reasons for these discrepancies are of major interest. In a prospective case-control study 760 patients with malignant and benign diseases of the pancreas were treated in our hospital between September 1, 1985 and April 30, 1997. In 221 cases (128 men, 93 women; mean age 61 years, range 23-83 years) a partial (n = 209) or total (n = 12) pancreaticoduodenectomy, in 12 cases combined with portal vein resection, was performed. Surgical complications were seen in 25%, but less than half of them were severe. General complications were seen in 18.5%. The 30- and 90-day mortality rates were 3.1%, and 5.7%, respectively. In a regression analysis the intraoperative blood loss, preoperative serum bilirubin, diameter of the pancreatic duct, and occurrence of surgical and nonsurgical complications had an independent influence on mortality. In addition to the experience of the surgeon in selecting the patients and his or her personal technical skills when performing a pancreaticoduodenectomy, better anticipation and management of postoperative complications is essential for improving the results of this operation.

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Section: Discussionmentioning

confidence: 74%

Section: Discussionmentioning

confidence: 79%

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Factors Influencing Morbidity and Mortality after Pancreaticoduodenectomy: Critical Analysis of 221 Resections

1999

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“…In the surgical treatment for pancreatic cancer (Whipple's procedure), for example, the hospital volume is of decisive importance for morbidity, mortality, and long-term patient survival [46,47,48,49,50]. This also appears to apply to thyroidectomy [51,52], resection of the liver [53,54], mastectomy/lumpectomy for breast cancer [55], and prostatectomy [56,57].…”

Section: Discussionmentioning

confidence: 99%

Effect of caseload on the short-term outcome of colon surgery: results of a multicenter study

Marusch

Koch

Schmidt

et al. 2001

Int J Colorectal Dis

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This prospective multicenter study investigated the effect of hospital caseload on early postoperative outcome of surgery for carcinoma of the colon in 75 German hospitals and included 2293 patients. The hospitals were divided into those with a caseload of 1-30 (group A), 31-60 (group B), and more than 60 (group C) operations. Increasing caseload was associated only with fewer general postoperative complications. It was also associated with significantly greater use of antibiotic prophylaxis. No significant differences between the groups were found in resection rates, intraoperative complications, specific postoperative complications, overall postoperative morbidity, hospital mortality, or 30-day mortality. The significance of hospital caseload for the short-term postoperative outcome following surgery on the colon should not be overestimated. Basing conclusions about the results to be expected simply on the case volume is impermissible. On the basis of the available data it is not possible to establish a threshold value, that is, a minimum number of required operations.

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“…Gordon et al [24] have used data from the Maryland Health Services Cost Review Commission to show that hospital mortality after PD was six times higher among patients treated at low-volume facilities than among patients treated at a high-volume regional provider (i.e., The Johns Hopkins Hospital). Similarly, Lieberman et al [25] used data from the New York State Department of Health Statewide Planning and Research Cooperative System to show that both crude and standardized (risk-adjusted) perioperative mortality rates after pancreatic resection were inversely related to hospital volume. These studies and others have clearly shown that the experience in a high-volume institution is associated with lower perioperative mortality and duration of hospitalization, when controlling for patient characteristics and co-morbidities.…”

Section: Discussionmentioning

confidence: 99%

Improving Results of Pancreaticoduodenectomy for Pancreatic Cancer

Yeo

Cameron

1999

World j. surg.

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This report from The Johns Hopkins Hospital reviews the results of pancreaticoduodenal resection during the decade of the 1990s, focusing on two recent publications. The first to be discussed involves a cohort of 650 consecutive patients undergoing pancreaticoduodenectomy (PD), with 443 patients having periampullary adenocarcinomas, 282 of whom had a pathologic diagnosis of pancreatic adenocarcinoma. The second report to be discussed involves the use of adjuvant chemoradiation therapy in a cohort of 174 patients who had successfully undergone PD for pancreatic adenocarcinoma. In both of these cohorts the operative mortality was less than 2%, and the median survival for resected pancreatic adenocarcinoma approximated 20 months.

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Relation of Perioperative Deaths to Hospital Volume Among Patients Undergoing Pancreatic Resection for Malignancy

Cited by 123 publications

References 0 publications

Factors Influencing Morbidity and Mortality after Pancreaticoduodenectomy: Critical Analysis of 221 Resections

Factors Influencing Morbidity and Mortality after Pancreaticoduodenectomy: Critical Analysis of 221 Resections

Effect of caseload on the short-term outcome of colon surgery: results of a multicenter study

Improving Results of Pancreaticoduodenectomy for Pancreatic Cancer

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