Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy

Birkmeyer, John D.; Finlayson, Samuel R.G.; Sharp, Sandra M.; Warshaw, Andrew L.

doi:10.1067/msy.1999.95211

Cited by 135 publications

(178 citation statements)

References 0 publications

Supporting

Mentioning

161

Contrasting

Unclassified

Order By: Relevance

“…(30,34) The Institute of Medicine released its synthesis of the evidence that 77% of peer-reviewed studies found significant inverse relationships between hospital volume and mortality (34); and another systematic review by Dudley et al (30,34) reported similar findings. Extremely strong volume-outcome relationships have been chiefly identified for rare and high-risk procedures, including coronary artery bypass graft surgery, (35)(36)(37)(38)(39)(40) pediatric cardiac surgery,(41-43) unruptured abdominal aortic aneurysm repair, (39,44,45) total hip replacement, (30,34,46,47) and very high risk cancer surgeries such as for the pancreas, (48)(49)(50)(51)(52) esophagus, (50,53,54) and liver cancers. (53) …”

Section: Volume-outcome Relationships In High-risk Surgeriesmentioning

confidence: 99%

Higher Volume and Better Outcomes Relationship in Kidney Transplant

Lee¹,

Ts'ao²,

Loong³

2012

Current Concepts in Kidney Transplantation

View full text Add to dashboard Cite

Section: Volume-outcome Relationships In High-risk Surgeriesmentioning

confidence: 99%

Higher Volume and Better Outcomes Relationship in Kidney Transplant

Lee¹,

Ts'ao²,

Loong³

2012

Current Concepts in Kidney Transplantation

View full text Add to dashboard Cite

“…Past studies from the medical literature have found that both hospitals and surgeons that perform more Whipple surgeries in a given year have lower mortality rates (Birkmeyer et al, 1999;Ho et al, 2002). Many researchers believe that this volume-outcome relation reflects "practice makes perfect" or "learning by doing" (Luft et al, 1979;Sturm, 1999).…”

mentioning

confidence: 99%

Regionalization versus competition in complex cancer surgery

Town

Heslin

2007

HEPL

View full text Add to dashboard Cite

The empirical association between high hospital procedure volume and lower mortality rates has led to recommendations for the regionalization of complex surgical procedures. While regionalization may improve outcomes, it also reduces market competition, which has been found to lower prices and improve health care quality. This study estimates the potential net benefits of regionalizing the Whipple surgery for pancreatic cancer patients. We confirm that increased hospital volume and surgeon volume are associated with lower inpatient mortality rates. We then predict the price and outcome consequences of concentrating Whipple surgery at hospitals that perform at least two, four, and six procedures respectively per year. Our consumer surplus calculations suggest that regionalization can increase consumer surplus, but potential price increases extract over half of the value of reduced deaths from regionalization. We reach three conclusions. First, regionalization can increase consumer surplus, but the benefits may be substantially less than implied by examining only the outcome side of the equation. Second, modest changes in outcomes due to regionalization may lead to decreases in consumer surplus. Third, before any regionalization policy is implemented, a deep and precise understanding of the nature of both outcome/volume and price/competition relationships is needed. Regionalization Versus Competition in Complex Cancer Surgery 3 ABSTRACTThe empirical association between high hospital procedure volume and lower mortality rates has led to recommendations for the regionalization of complex surgical procedures. While regionalization may improve outcomes, it also reduces market competition, which has been found to lower prices and improve health care quality. This study estimates the potential net benefits of regionalizing the Whipple surgery for pancreatic cancer patients. We confirm that increased hospital volume and surgeon volume are associated with lower inpatient mortality rates. We then predict the price and outcome consequences of concentrating Whipple surgery at hospitals that perform at least 2, 4 and 6 procedures respectively per year. Our consumer surplus calculations suggest that regionalization can increase consumer surplus, but potential price increases extract over half of the value of reduced deaths from regionalization. We reach three conclusions. First, regionalization can increase consumer surplus, but the benefits may be substantially less than implied by examining only the outcome side of the equation. Second, modest changes in outcomes due to regionalization may lead to decreases in consumer surplus. Third, before any regionalization policy is implemented, a deep and precise understanding of the nature of both outcome/volume and price/competition relationships is needed.

show abstract

“…This selective approach avoids the risks of operation in patients with benign lesions, but with current limitations in non-resectional diagnosis, cannot guarantee that a malignancy is not mistakenly being observed. Operative mortality rates following pancreatectomy range between 2 and 15 % and significant postoperative complications occur in approximately 45 % of patients [9]. Our data suggest that with current imaging and endoscopic techniques, a group of patients with pancreatic cysts can be identified with a malignancy rate of <3 % [8].…”

mentioning

confidence: 77%

Cystic Lesions of the Pancreas: Observe or Operate

Allen

2015

Indian J Surg

View full text Add to dashboard Cite

A cystic lesion of the pancreas is a radiographic finding that has a broad histologic differential. This differential includes non-neoplastic pseudocysts, benign neoplastic cysts, premalignant cysts, and cystic lesions with invasive carcinoma [1]. Because of the increased use of high-quality cross-sectional imaging, an increasing number of patients are being identified with small asymptomatic cysts, and the management of these patients has become very controversial [2,3]. This controversy has centered on the inability to determine the exact histopathologic diagnosis without resection. Because of this diagnostic uncertainty, many authors have recommended routine resection of all pancreatic cysts [4,5]. It should be emphasized, however, that the ability to determine the histologic diagnosis of pancreatic cysts without resection continues to improve, and current imaging and endoscopic techniques can typically differentiate benign serous from pre-cancerous mucinous cysts of the pancreas. In addition, even within the mucinous sub-group, our ability to detect high-risk lesions is improving.Because of these improvements in diagnosis, we have recommended a more selective approach to resection [6][7][8]. We have found that with current imaging techniques, and with an improved understanding of the various histologic entities, a group of patients can be identified who have an extremely low risk of malignancy. Within this group of patients, we routinely recommend non-operative management (radiographic followup). These patients typically have small (<3 cm), incidentally discovered cysts of the pancreas that do not have a solid component or other concerning clinical or radiographic features of malignancy (such as main pancreatic duct dilation). This selective approach avoids the risks of operation in patients with benign lesions, but with current limitations in non-resectional diagnosis, cannot guarantee that a malignancy is not mistakenly being observed. Operative mortality rates following pancreatectomy range between 2 and 15 % and significant postoperative complications occur in approximately 45 % of patients [9]. Our data suggest that with current imaging and endoscopic techniques, a group of patients with pancreatic cysts can be identified with a malignancy rate of <3 % [8]. In this group of patients, the risk of death from pancreatectomy exceeds the risk of the lesion being malignant and radiographic surveillance should be recommended.When the histopathology of a given cyst can be determined non-operatively, the treatment recommendations may be less challenging. In these instances, treatment recommendations can be made based on the known natural history of the specific histologic entity. For instance, when diagnostic evaluation identifies a patient with a serous cystadenoma (SCA), radiographic surveillance should be the routine recommendation. Resection for SCA should be reserved for the symptomatic patient, or in a healthy patient in whom significant growth has been observed. Patients identified with mucinous cystic ne...

show abstract

Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy

Abstract: Although volume-outcome relationships have been reported for many complex surgical procedures, hospital experience is particularly important with pancreaticoduodenectomy. Patients considering this procedure should be given the option of care at a high-volume referral center.

Cited by 135 publications

References 0 publications

Higher Volume and Better Outcomes Relationship in Kidney Transplant

Higher Volume and Better Outcomes Relationship in Kidney Transplant

Regionalization versus competition in complex cancer surgery

Cystic Lesions of the Pancreas: Observe or Operate

Contact Info

Product

Resources

About