The Impact of Regionalization of Pancreaticoduodenectomy for Pancreatic Cancer in North Carolina since 2004

Swan, Ryan Z.; Niemeyer, David J.; Seshadri, Ramanathan; Thompson, Kyle J.; Walters, Amanda L.; Martinie, John B.; Sindram, David; Iannitti, David A.

doi:10.1177/000313481408000619

Cited by 34 publications

(31 citation statements)

References 26 publications

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“…Regionalization of hepatobiliary surgery in the United States beginning in 2000 led to a 40% lower operative mortality rate 27 ; natural regionalization of pancreatic surgery was associated with lower mortality in Maryland 28 but not in North Carolina. 29 There have been no clinical trials of interventions to regionalize surgery. We also found a mortality difference before and after regionalization, similar to previous studies, but our interrupted time series analysis was able to distinguish the effect of regionalization on outcomes from other confounding exposures, such as improvements in the quality and outcomes of care over time.…”

Section: Discussionmentioning

confidence: 99%

Regionalization and Outcomes of Lung Cancer Surgery in Ontario, Canada

Bendzsak¹,

Baxter²,

Darling³

et al. 2017

JCO

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Purpose Regionalization of complex surgery to high-volume hospitals has been advocated based on cross-sectional volume-outcome studies. In April 2007, the agency overseeing cancer care in Ontario, Canada, implemented a policy to regionalize lung cancer surgery at 14 designated hospitals, enforced by economic incentives and penalties. We studied the effects of implementation of this policy. Methods Using administrative health data, we used interrupted time series models to analyze the immediate and delayed effects of implementation of the policy on the distribution of lung cancer surgery among hospitals, surgical outcomes, and health services use. Results From 2004 to 2012, 16,641 patients underwent surgery for lung cancer. The proportion of operations performed in designated hospitals increased from 71% to 89% after the policy was implemented. Although operative mortality decreased from 4.1% to 2.9% (adjusted odds ratio, 0.68; 95% CI, 0.58 to 0.81; P < .001), the reduction was due to a preexisting declining trend in mortality. In contrast, in the years after implementation of the policy, length of hospital stay decreased more than expected from the baseline trend by 7% per year (95% CI, 5% to 9%; P < .001), and the distance traveled by all patients to the hospital for surgery increased by 4% per year (95% CI, 0% to 8%; P = .03), neither of which were explained by preexisting trends. Analyses limited to patients ≥ 70 years of age demonstrated a reduction in operative mortality (odds ratio, 0.80 per year after regionalization; 95% CI, 0.67 to 0.95; P = .01). Conclusion A policy to regionalize lung cancer surgery in Ontario led to increased centralization of surgery services but was not independently associated with improvements in operative mortality. Improvements in length of stay and in operative mortality among elderly patients suggest areas where regionalization may be beneficial.

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Section: Discussionmentioning

confidence: 99%

Regionalization and Outcomes of Lung Cancer Surgery in Ontario, Canada

Bendzsak¹,

Baxter²,

Darling³

et al. 2017

JCO

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“…Centralization of PD to high-volume centers collaborating within oncology networks might bring a solution as long as high-quality care is guaranteed. Within the described GIOCA collaboration, the 30-day and 90-day mortality is within the range of other high-volume centers, which has been reported to be 0–3.8% versus 4.3–7.3%, respectively [2, 22–25].…”

Section: Discussionmentioning

confidence: 84%

Regional oncology network between pancreatic centers safeguards waiting times for pancreatoduodenectomy

et al. 2019

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Pancreatoduodenectomy (PD) is increasingly performed in high-volume centers, which may compromise waiting times. The aim of this study was to evaluate patient flow and outcome of PD within a regional oncology network of two high-volume centers. A post hoc analysis of a partially retrospective and prospective database was performed of all patients who underwent PD for pancreatic or periampullary neoplasms in both centers of the Gastrointestinal Oncology Center Amsterdam, a collaboration between an academic center and affiliated general teaching hospital, from 2010 to 2014. Outcomes included waiting time to surgery and postoperative morbidity and mortality. A total of 525 PDs were performed, 329 in the academic center (annual volume 66) and 196 in the teaching hospital (annual volume 39). Neoadjuvant treatment was more often used in the academic center, other baseline characteristics were similar. Overall time to surgery was 26 days, which was significantly less in the teaching hospital. The major postoperative morbidity rate was 38.3% (n = 201), and the 30- and 90-day mortality was 2.3% and 3.6%. A regional oncology network between an academic center and a general teaching hospital for PD can be an attractive option to safeguard waiting times in selected patients, without compromising outcome.

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“…Centralisation of pancreatic surgical services has led to improved outcomes including higher resection rates [ 7 , 8 ], lower operative mortality [ 9 , 10 ] and improved long-term survival [ 11 ]. Similar improvements with centralisation have been noted for liver [ 12 ], oesophageal [ 13 ], complex urological [ 14 ] and vascular surgery [ 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite these findings the population benefits of regionalisation are more difficult to demonstrate. Although studies using hospital data have demonstrated improved outcomes associated with centralisation of surgical services for patients who receive treatment [ 8 , 16 , 17 ], these studies may be biased by selection of patients at the regional centres and do not take into account patients who are not referred for treatment. Studies demonstrating improved population outcomes as a result of regionalisation of complex surgery are more difficult to undertake.…”

Section: Discussionmentioning

confidence: 99%

Variation in survival after surgery for peri-ampullary cancer in a regional cancer network

et al. 2017

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BackgroundCentralisation of specialist surgical services requires that patients are referred to a regional centre for surgery. This process may disadvantage patients who live far from the regional centre or are referred from other hospitals by making referral less likely and by delaying treatment, thereby allowing tumour progression. The aim of this study is to explore the outcome of surgery for peri-ampullary cancer (PC) with respect to referring hospital and travel distance for treatment within a network served by five hospitals.MethodsReview of a unit database was undertaken of patients undergoing surgery for PC between January 2006 and May 2014.Results394 patients were studied. Although both the median travel distance for patients from the five hospitals (10.8, 86, 78.8, 54.7 and 89.2 km) (p < 0.05), and the annual operation rate for PC (2.99, 3.29, 2.13, 3.32 and 3.07 per 100,000) (p = 0.044) were significantly different, no correlation was noted between patient travel distance and population operation rate at each hospital. No difference was noted between patients from each hospital in terms of resection completion rate or pathological stage of the resected tumours. The median survival after diagnosis for patients referred from different hospitals ranged from 1.2 to 1.7 years and regression analysis revealed that increased travel distance to the regional centre was associated with a small survival advantage.ConclusionAlthough variation in the provision and outcome of surgery for PC between regional hospitals is noted, this is not adversely affected by geographical isolation from the regional centre.Trial registrationThis study is part of post-graduate research degree project. The study is registered with ClinicalTrials.gov (unique identifier NCT02296736) November 18, 2014.

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The Impact of Regionalization of Pancreaticoduodenectomy for Pancreatic Cancer in North Carolina since 2004

Cited by 34 publications

References 26 publications

Regionalization and Outcomes of Lung Cancer Surgery in Ontario, Canada

Regionalization and Outcomes of Lung Cancer Surgery in Ontario, Canada

Regional oncology network between pancreatic centers safeguards waiting times for pancreatoduodenectomy

Variation in survival after surgery for peri-ampullary cancer in a regional cancer network

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