Surgeon Volume Versus Morbidity and Cost in Patients Undergoing Pancreaticoduodenectomy in an Academic Community Medical Center

Kennedy, Timothy J.; Cassera, Maria A.; Wolf, Ronald; Swanstrom, Lee L.; Hansen, Paul

doi:10.1007/s11605-010-1280-1

Cited by 38 publications

(22 citation statements)

References 32 publications

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“…Despite that our overall duration of stay could seem longer than those described by others, 31,43,63,64 especially by US centers, 65,66 immediate postoperative outcomes in group 14p invasion were identical or easier than others, as evidenced by comparable mean duration of stay (21 vs 23 days) or absence of grade IV/V complications. Despite that our overall duration of stay could seem longer than those described by others, 31,43,63,64 especially by US centers, 65,66 immediate postoperative outcomes in group 14p invasion were identical or easier than others, as evidenced by comparable mean duration of stay (21 vs 23 days) or absence of grade IV/V complications.…”

Section: Discussioncontrasting

confidence: 49%

Lymph Node Involvement Beyond Peripancreatic Region in Pancreatic Head Cancers

Golse¹,

Lebeau²,

Lombard‐Bohas³

et al. 2013

Pancreas

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Section: Discussioncontrasting

confidence: 49%

Lymph Node Involvement Beyond Peripancreatic Region in Pancreatic Head Cancers

Golse¹,

Lebeau²,

Lombard‐Bohas³

et al. 2013

Pancreas

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“…Previous studies showed the relationship between high hospital‐volume and surgeon‐volume on a lower incidence of complications and quality of care . It seems fair to say that cost savings can be achieved nation‐wide by performing pancreatic surgery only in high‐volume hospitals and by experienced surgeons …”

Section: Discussionmentioning

confidence: 99%

“…Previous studies showed the relationship between high hospital-volume and surgeon-volume on a lower incidence of complications and quality of care. 11,[39][40][41] It seems fair to say that cost savings can be achieved nation-wide by performing pancreatic surgery only in high-volume hospitals and by experienced surgeons. 21 The overall complication rate in the present study was higher than in previous reports from our hospital as well as from other contemporary studies despite a 1% mortality.…”

Section: Hpbmentioning

confidence: 99%

Hospital costs of complications after a pancreatoduodenectomy

Santema

Visser

Busch

et al. 2015

HPB

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“…Multiple previous studies have demonstrated that increased procedure volume leads to a dramatic decrease in perioperative mortality. 22–26 Specifically, Kennedy et al 22 found that high-volume PD surgeons have better outcomes including complication rates and overall mortality. In the current study, we also noted that in-hospital and 90-day mortality were higher among lower-volume hospitals and surgeons.…”

Section: Discussionmentioning

confidence: 99%

Influence of Patient, Physician, and Hospital Factors on 30-Day Readmission Following Pancreatoduodenectomy in the United States

et al. 2013

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IMPORTANCE It is not known whether hospital and surgeon volumes have an association with readmission among patients undergoing pancreatoduodenectomy. OBJECTIVE To evaluate patient-, surgeon-, and hospital-level factors associated with readmission. DESIGN, SETTING, AND PARTICIPANTS Retrospective cohort study using the Surveillance, Epidemiology, and End Results (SEER)–Medicare data with cases diagnosed from January 1, 1998, to December 31, 2005, and followed up until December 2007. Population-based cancer registry data were linked to Medicare data for the corresponding patients. A total of 1488 unique individuals who underwent a pancreatoduodenectomy were identified. INTERVENTIONS Undergoing pancreatoduodenectomy at hospitals classified by volume of pancreatoduodenectomy procedures performed at the facility were either very-low, low, medium, or high volume. Undergoing pancreatoduodenectomy by surgeons classified by volume of pancreatoduodenectomy procedures performed by the surgeon were either very-low, low, medium, or high volume. MAIN OUTCOMES AND MEASURES In-hospital morbidity, mortality, and 30-day readmission were examined. RESULTS The median age was 74 years, and 1436 patients (96.5%) had a least 1 medical comorbidity. Patients were treated by 575 distinct surgeons at 298 distinct hospitals. Length of stay was longest (median, 17 days) and 90-day mortality highest (17.2%) at very-low-volume hospitals (P < .001). Among all pancreatoduodenectomy patients, 292 (21.3%) were readmitted within 30 days of discharge. There was no effect of surgeon volume and a modest effect of hospital volume (odds ratio for highest- vs lowest-volume quartiles, 1.85; 95% CI, 1.22–2.80; P = .02). The presence of significant preoperative medical comorbidities was associated with an increased risk for hospital readmission after pancreatoduodenectomy. A comorbidity score greater than 13 had a pronounced effect on the chance of readmission following pancreatoduodenectomy (odds ratio, 2.06; 95% CI, 1.56–2.71; P < .001). The source of variation in readmission was primarily attributable to patient-related factors (95.4%), while hospital factors accounted for 4.3% of the variability and physician factors for only 0.3%. CONCLUSIONS AND RELEVANCE Nearly 1 in 5 patients are readmitted following pancreatoduodenectomy. While variation in readmission is, in part, attributable to differences among hospitals, the largest share of variation was found at the patient level.

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Surgeon Volume Versus Morbidity and Cost in Patients Undergoing Pancreaticoduodenectomy in an Academic Community Medical Center

Abstract: Surgeon volume and patient body mass index have a significant impact on perioperative morbidity following PD in a community teaching hospital.

Cited by 38 publications

References 32 publications

Lymph Node Involvement Beyond Peripancreatic Region in Pancreatic Head Cancers

Lymph Node Involvement Beyond Peripancreatic Region in Pancreatic Head Cancers

Hospital costs of complications after a pancreatoduodenectomy

Influence of Patient, Physician, and Hospital Factors on 30-Day Readmission Following Pancreatoduodenectomy in the United States

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