Identifying the Optimal case-volume threshold for pancreatectomy in contemporary practice - 10/02/22
, Yu-Hui H. Chang b, c , David A. Etzioni a, c , Amit K. Mathur a, c , Elizabeth B. Habermann c , Nabil Wasif a, ⁎ Abstract |
Background |
The volume-mortality association led to regionalization recommendations for pancreatic surgery. Mortality following pancreatectomy has declined, but case-volume thresholds remain unchanged.
Methods |
Patients undergoing pancreatectomy from 2004 to 2013 were identified in the National Cancer Database (NCDB). Hospitals were divided into low (LV), medium (MV), and high-volume (HV) strata using 30-day mortality quartiles and logistic regression with cubic splines. Adjusted absolute difference and odds of 30-day mortality between strata were calculated.
Results |
Annual volumes for LV, MV, and HV were <4, 4–18 and > 18 cases using quartiles and <6, 6–18 and > 18 using cubic splines. Absolute 30-day mortality trended downwards, with differential improvements for MV and LV. Benchmark 30-day mortality for hospitals with >18 cases was 2.8%. For this benchmark, the case-volume threshold decreased from 31 in 2004 to 6 in 2013.
Conclusion |
Differential improvement in 30-day mortality at LV and MV hospitals led to similar 30-day mortality odds at MV and HV hospitals by 2013.
Le texte complet de cet article est disponible en PDF.Graphical abstract |
Highlights |
• | 30-day mortality following pancreatectomy decreased between 2003 and 2014. |
• | 30-day mortality decreased more at low & medium-volume than at high-volume centers. |
• | Medium and high-volume hospitals had similar postoperative mortality by 2013. |
• | A majority of patients undergo pancreatic surgery at medium-volume centers. |
• | Lower regionalization volume thresholds may be practical for policy implementation. |
Keywords : Pancreatectomy, Volume-outcomes relationship, Regionalization
Plan
Vol 223 - N° 2
P. 318-324 - février 2022 Retour au numéro
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