Surgeon Volume Impacts Hospital Mortality for Pancreatic Resection

Eppsteiner, Robert W.; Csikesz, Nicholas G.; McPhee, James T.; Tseng, Jennifer F.; Shah, Shimul A.

doi:10.1097/sla.0b013e31819ed958

Cited by 159 publications

(90 citation statements)

References 33 publications

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“…There are many surgeon‐specific factors that affect post‐operative morbidity, such as age, gender, extent and type of training and operative volume or workload. Higher surgeon volumes in pancreatic surgery have been linked to an overall improvement in patient outcomes, including reduced intraoperative blood loss, shorter hospital stay, lower pancreas fistula rate and improved mortality 1, 9. However, Waljee et al 14.…”

Section: Discussionmentioning

confidence: 99%

“…It is generally reported that the incidence of clinically relevant post‐operative pancreatic fistulas after PD is 7.6–36.4%,1, 2, 3, 4, 5 in accordance to the definition of the International Study Group of Pancreatic Fistula (ISGPF) 6. Researchers have suggested factors that affect pancreatic leakage after PD, including male gender, advanced age, post‐operative albumin level, intraoperative bleeding, soft pancreatic parenchyma, small pancreatic duct, drain amylase level on post‐operative day one, pancreatic parenchymal thickness and surgeon volume, among others 1, 7, 8, 9, 10, 11, 12, 13, 14…”

Section: Introductionmentioning

confidence: 99%

“…Although several surgeon‐related factors affecting post‐operative morbidity in pancreatic surgery have been reported,9, 14, 15 there have been no articles reporting links between surgical outcome and the surgeon's level of alertness or burnout. A higher surgeon workload may result in increasing fatigue and reduce the surgeon's ability to concentrate on the procedure.…”

Section: Introductionmentioning

confidence: 99%

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Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula

Kim

Choi

et al. 2015

ANZ Journal of Surgery

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BackgroundMany studies have reported factors affecting pancreatic leakage after pancreaticoduodenectomy (PD), but there have been few reports on surgeon workload and post‐operative pancreatic fistula (POPF). This study was conducted to explore whether a surgeon's workload during PD impacts the occurrence of POPF.MethodsWe retrospectively analysed 270 consecutive patients who underwent PD between January 2008 and June 2013 by a single experienced surgeon. These patients were divided into those who underwent PD entirely by a single operator (group 1) and those who received reconstructions by other operators (group 2). Duct‐to‐mucosa pancreaticojejunostomy was performed on all patients. The International Study Group on Pancreatic Fistula criteria were used to define POPF.ResultsThere were 157 patients (58.1%) in group 1 and 113 patients (41.9%) in group 2. The post‐operative morbidity rate was comparable between the two groups (55.4% versus 52.2%; P = 0.603), but the clinical pancreatic fistula (grade B/C) rate was significantly different (10.8% versus 2.7%; P = 0.011). The overall post‐operative mortality was one patient (0.4%). Significant associations were found between clinical pancreatic fistulas and soft pancreas texture (P = 0.021), preoperative serum albumin level ≤3.5 g/dL (P = 0.012), other pathology besides pancreatic cancer (P = 0.027) and a single‐operator procedure (P = 0.019). A multivariate logistic regression analysis revealed that a single operator (odds ratio: 4.2, P = 0.029) was a significant predictive risk factor for clinically relevant POPF.ConclusionDividing the surgeon's workload in PD is associated with lower rates of POPF.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula

Kim

Choi

et al. 2015

ANZ Journal of Surgery

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“…impacto del volumen por cirujano en la mortalidad hospitalaria La presencia de tasas de mortalidad operatoria menores en los centros de alto volumen después de la resección pancreática [3][4][5][6][7][8]15,16 ha planteado también el impacto del volumen cirujano en la mortalidad.…”

Section: Pancreatoduodenectomíaunclassified

Relación Entre El Volumen Quirúrgico Y Los Resultados Postoperatorios en Esofaguectomía Y Pancreatectomía Por Cáncer

et al. 2016

Rev Chil Cir

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abstractinverse relationship between intervention volume and complications of esophagectomy and pancreatectomy. a review background: The prevalence of pancreatic cancer increased in Chile in the last decade, while that of esophageal cancer is decreasing. Both diseases are a surgical challenge due to their high mortality and rate of complications. aim: To analyze the relationship between intervention volume and surgical complications. material and methods: We reviewed 19 papers analyzing the relationship between the number of interventions performed in a determinate hospital (yearly hospital volume), the number of interventions performed by each surgeon (yearly surgical volume) and the rates of mortality and complications of both conditions. results: There is a clear inverse relationship between volumes and complications. There is also a higher five years survival in high volume hospitals. conclusions: Intervention volume is inversely associated with rates of complications.

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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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Surgeon Volume Impacts Hospital Mortality for Pancreatic Resection

Abstract: After controlling for patient demographics and factors, pancreatic resection by a HV surgeon in this case-controlled cohort was independently associated with a 51% reduction in in-hospital mortality.

Cited by 159 publications

References 33 publications

Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula

Division of surgeon workload in pancreaticoduodenectomy: striving to decrease post‐operative pancreatic fistula

Relación Entre El Volumen Quirúrgico Y Los Resultados Postoperatorios en Esofaguectomía Y Pancreatectomía Por Cáncer

Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

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