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

Abstract

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.

Transitioning to a high volume centre for Whipple pancreaticoduodenectomy in Western Australia: a single centre experience

“…Close to a third of the Australian population reside outside of major cities 7 . Assessment of post‐operative inpatient mortality in patients who had a PD in Victoria did not demonstrate a relationship between surgical volume and outcomes with the highest volume hospital recording an average of 20 PDs per year 8 . Comparison between regional and city centres did not demonstrate a difference in post‐operative inpatient mortality in the states of Queensland, Victoria and New South Wales 9 …”

Pancreaticoduodenectomy in Australia: a national quality improvement clinical registry is long overdue

“…comm., 2021). Previous studies from other Australian states suggest an overall mortality between 3% and 4%, [8][9][10][12][13][14][15][16][17][18][19][20] similar to Europe, but greater than the USA. [21][22][23] Almost one-fifth of American patients offered a PD would accept a sixfold increased risk in exchange for locally delivered care.…”

Is volume really all that matters?

“…In the current issue of the journal, two papers assess the relationship of hospital volume versus outcome in Australia, and both conclude that there is not a strong correlation between hospital volume and short‐term outcomes after pancreaticoduodenectomy (PD). Stevens and Watters reviewed 547 patients who underwent PD at 10 hospitals over a 6‐year period.…”

“…In the current issue of the journal, two papers assess the relationship of hospital volume versus outcome in Australia, and both conclude that there is not a strong correlation between hospital volume and short‐term outcomes after pancreaticoduodenectomy (PD). Stevens and Watters reviewed 547 patients who underwent PD at 10 hospitals over a 6‐year period. In this study, the investigators included six principal referral hospitals (PRHs – have specialist facilities not typically found in smaller hospitals) and four public group A hospitals (PGA – do not provide the breadth of services of referral hospitals).…”

“…In smaller but well‐developed healthcare systems like Australia, surgical volume probably does matter but so do the other factors in determining outcome from PD. The data in the papers of Stevens and Watters and Davies et al . serve as an excellent starting point to begin a wider examination of what defines the ultimate treatment pathway for patients with pancreatic cancer.…”