A Partnership Model Between High- and Low-Volume Hospitals to Improve Results in Hepatobiliary Pancreatic Surgery

Ravaioli, Matteo; Pinna, Antonio Daniele; Francioni, Gianfranco; Montorsi, Marco; Veneroni, Luigi; Grazi, Gian Luca; Palini, Gian Marco; Gavazzi, Francesca; Stacchini, Giacomo; Ridolfi, Cristina; Serenari, Matteo; Zerbi, Alessandro

doi:10.1097/sla.0000000000000975

Cited by 40 publications

(29 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Vallance and colleagues 20 showed in a study from the UK, of more than 4500 patients treated between 2010 and 2014, that a centralized hepatobiliary service was associated with higher resection rates (OR 1⋅52) and better outcomes (median survival 30⋅5 versus 25⋅6 months). An alternative has been published by Ravaioli et al 21 , who established a partnership model with open multidisciplinary boards at three different Italian hospitals. In this model, the number of procedures at the small centre went up, while the complication and mortality rates fell to values similar to those at the high-volume centre.…”

Section: Discussionmentioning

confidence: 99%

Mortality after liver surgery in Germany

Filmann

Walter

Schadde

et al. 2019

British Journal of Surgery

131

View full text Add to dashboard Cite

Background: Mortality rates after liver surgery are not well documented in Germany. More than 1000 hospitals offer liver resection, but there is no central regulation of infrastructure requirements or outcome quality.Methods: Hospital mortality rates after liver resection were analysed using the standardized hospital discharge data (Diagnosis-Related Groups, ICD-10 and German operations and procedure key codes) provided by the Research Data Centre of the Federal Statistical Office and Statistical Offices of the Länder in Wiesbaden, Germany.Results: A total of 110 332 liver procedures carried out between 2010 and 2015 were identified. The overall hospital mortality rate for all resections was 5⋅8 per cent. The mortality rate among 17 574 major hepatic procedures was 10⋅4 per cent. Patients who had surgery for colorectal liver metastases (CRLMs) had the lowest mortality rate among those with malignancy (5⋅5 per cent), followed by patients with gallbladder cancer (7⋅1 per cent), hepatocellular carcinoma (9⋅3 per cent) and intrahepatic cholangiocarcinoma (11⋅0 per cent). Patients with extrahepatic cholangiocarcinoma had the highest mortality rate (14⋅6 per cent). The mortality rate for extended hepatectomy was 16⋅2 per cent and the need for a biliodigestive anastomosis increased this to 25⋅5 per cent. Failure to rescue after complications led to mortality rates of more than 30 per cent in some subgroups. There was a significant volume-outcome relationship for CRLM surgery in very high-volume centres (mean 26-60 major resections for CRLMs per year). The mortality rate was 4⋅6 per cent in very high-volume centres compared with 7⋅5 per cent in very low-volume hospitals (odds ratio 0⋅60, 95 per cent c.i. 0⋅42 to 0⋅77; P < 0⋅001).Conclusion: This analysis of outcome data after liver resection in Germany suggests that hospital mortality remains high. There should be more focused research to understand, improve or justify factors leading to this result, and consideration of centralization of liver surgery.

show abstract

Section: Discussionmentioning

confidence: 99%

Mortality after liver surgery in Germany

Filmann

Walter

Schadde

et al. 2019

British Journal of Surgery

131

View full text Add to dashboard Cite

show abstract

“…Although to our knowledge the association between hospital volume and patient outcomes has begun to be examined only recently for patients with sarcomas, it has been extensively examined across other patient populations. [6][7][8]11,20,26 Compared with treatment at LVHs, treatment at HVHs has been associated with improved patient outcomes after various complex oncologic resections, including head and neck surgery, 12 esophagectomy, 9,15,16 colorectal surgery, 9,17,27 HPB,9,19,20,28 cystectomy, 13 nephrectomy, 10 and major lung resection. 14 The relationship between hospital volume and patient outcomes may reflect differences in multiple aspects of the multidisciplinary care of the oncology patient undergoing complex surgical resection, such as the patient with primary resectable RPS.…”

Section: Discussionmentioning

confidence: 99%

Treatment at low‐volume hospitals is associated with reduced short‐term and long‐term outcomes for patients with retroperitoneal sarcoma

Keung

Chiang

Cormier

et al. 2018

Cancer

117

View full text Add to dashboard Cite

Background Retroperitoneal sarcomas (RPS) are rare tumors for which complete surgical resection remains the mainstay of treatment. We sought to determine the impact of hospital case volume on RPS outcomes. Methods We identified 6950 patients with primary RPS who underwent surgical resection from the National Cancer Data Base (1998–2011). Treating hospitals were classified by annual case volume; low volume hospitals (LVHs) and high volume hospitals (HVHs) were defined as ≤10 and >10 cases/year, respectively. Overall survival (OS) was compared using Kaplan-Meier curves. Cox proportional hazard models were created to compare risks. Results Of 1131 reporting hospitals, most (n=1127, 99.6%) were LVHs treating the majority of patients (n=6270; 90.2%). Patients treated at LVHs were more likely to have lower grade and smaller tumors, receive radiation therapy, and undergo incomplete gross (R2) resection. Patients treated at HVHs had lower 30-day readmission rates (1.8% vs 3.4%, p<0.001), 30-day (1.9% vs 3.1%, p=0.004) and 90-day mortality (3.2% vs 5.7%, p=0.007); longer median OS (76.2 vs 64.2 months, p<0.001) and higher 5-year OS (58% vs 52%, p<0.001). After controlling for age, gender, insurance status, tumor size, tumor grade, resection margin status, and radiation administration, treatment at a HVH was independently associated with a reduced risk of death (HR 0.77, 95% CI 0.65–0.91, p=0.003). Conclusion Primary RPS are rare tumors for which few surgeons and institutions have significant experience and expertise in their multidisciplinary management and surgical resection. Although additional studies are needed, patient outcomes may be impacted by treating facility case volume and experience.

show abstract

“…Such mentoring relationships likely already informally exist at many institutions, and studies of formal mentoring programs suggest it is an effective strategy to optimize outcomes. 16 Similarly, partnership between hospitals that were high and low volume in hepatobiliary surgery has resulted in improvements to postoperative outcomes; 17 however, such partnerships may come across regulatory obstacles depending on the local political and economic environment. Therefore, additional work should evaluate the effectiveness of pairing low volume early career or general surgeons with experienced mentors to determine what types of mentoring partnerships are most beneficial.…”

Section: Discussionmentioning

confidence: 99%

Is Annual Volume Enough? The Role of Experience and Specialization on Inpatient Mortality After Hepatectomy

et al. 2017

View full text Add to dashboard Cite

Objective To investigate the effect of subspecialty practice and experience on the relationship between annual volume and inpatient mortality following hepatic resection. Summary Background Data The impact of annual surgical volume on post-operative outcomes has been extensively examined. However, the impact of cumulative surgeon experience and specialty training on this relationship warrants investigation. Methods The New York Statewide Planning and Research Cooperative System inpatient database was queried for patients ≥18 years who underwent wedge hepatectomy or lobectomy from 2000-2014. Primary exposures included annual surgeon volume, surgeon experience (early vs. late career), and surgical specialization – categorized as general surgery (GS), surgical oncology (SO), and transplant (TS). Primary endpoint was inpatient mortality. Hierarchical logistic regression was performed accounting for correlation at the level of the surgeon and the hospital, and adjusting for patient demographics, comorbidities, presence of cirrhosis, and annual surgical hospital volume. Results 13,467 cases were analyzed. Overall inpatient mortality was 2.35%. On unadjusted analysis, late career surgeons had a mortality rate of 2.62% versus 1.97% for early career surgeons. GS had a mortality rate of 2.98% compared to 1.68% for SO and 2.67% for TS. Once risk-adjusted, annual volume was associated with reduced mortality only among early-career surgeons (OR 0.82, p=0.001) and general surgeons (OR 0.69, p=0.01). No volume effect was seen among late-career or specialty-trained surgeons. Conclusion Annual volume alone likely contributes only a partial assessment of the volume-outcome relationship. In patients undergoing hepatic resection, increased annual volume did not confer a mortality benefit on subspecialty surgeons or late career surgeons.

show abstract

A Partnership Model Between High- and Low-Volume Hospitals to Improve Results in Hepatobiliary Pancreatic Surgery

Abstract: Our partnership model helped improve postoperative outcomes at the LV center. Results at the LV hospital were comparable with the HV centers, although 2 years of partnership were required to achieve this in pancreatic surgery.

Cited by 40 publications

References 17 publications

Mortality after liver surgery in Germany

Mortality after liver surgery in Germany

Treatment at low‐volume hospitals is associated with reduced short‐term and long‐term outcomes for patients with retroperitoneal sarcoma

Is Annual Volume Enough? The Role of Experience and Specialization on Inpatient Mortality After Hepatectomy

Contact Info

Product

Resources

About