Surgical Outcomes ResearchEffect of hospital volume on in-hospital mortality with pancreaticoduodenectomy☆,☆☆,★
Section snippets
Subjects and databases
As part of our work on the Dartmouth Atlas of Health Care in the United States ,14 by use of the Health Care Financing Administration's 100% MEDPAR file, we studied patients undergoing pancreaticoduodenectomy. This file contains diagnosis and procedure codes from hospital discharge abstracts for all Medicare hospitalizations (except those of the 8% of Medicare patients enrolled in risk-bearing health maintenance organizations during this time period). We included all patients more than 65 years
Volume and patient characteristics
Of 7229 Medicare patients undergoing pancreaticoduodenectomy between 1992 and 1995, 3833 patients (53%) received care at low- or very-low-volume institutions (those performing fewer than 2 per year in Medicare patients) (Table I). Of these, 1988 patients (28%) underwent surgery at 1203 hospitals performing fewer than 1 pancreaticoduodenectomy annually. Conversely, 1541 patients (21%) underwent pancreaticoduodenectomy at 40 hospitals performing at least 5 per year in Medicare patients, including
Discussion
Inverse relationships between hospital volume and mortality with high-risk surgical procedures have long been recognized.7, 8, 9, 10 What distinguishes the findings of our analysis of pancreaticoduodenectomy is the magnitude of the volume-outcome effect. Between 1992 and 1995, more than 50% of Medicare patients undergoing pancreaticoduodenectomy received care at hospitals performing fewer than 2 such procedures per year. In-hospital mortality rates at these low- and very-low-volume hospitals
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2022, PancreatologyCitation Excerpt :The most common major complication after pancreatoduodenectomy is leakage of the pancreato-enteric anastomosis which can result in postoperative pancreatic fistula (POPF) development, delayed gastric emptying, postpancreatectomy hemorrhage, and death [1]. Although mortality after pancreatoduodenectomy has decreased to approximately 2% in high-volume centers, the morbidity after these procedures still remains between 30 and 50% mainly due to POPF, of which the incidence varies between 10 and 30% [2–5]. Well-known risk factors of POPF are soft texture of the pancreas without pre-existing fibrosis, small pancreatic duct size, tension on the anastomosis, poor anastomotic perfusion and surgeon's experience with the procedure [6].
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Supported in part by a grant from the Robert Wood Johnson Foundation.
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The views expressed herein do not necessarily reflect the views of the Health Care Financing Administration, the Department of Veterans Affairs, or the United States government.
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Reprint requests: John D. Birkmeyer, MD, VA Outcomes Group (111B), Department of Veterans Affairs Medical Center, White River Junction, VT 05009.