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Pancreaticoduodenectomy - the transition from a low- to a high-volume center.

Ansari, Daniel LU ; Williamsson, Caroline; Tingstedt, Bobby LU ; Andersson, Bodil LU ; Lindell, Gert LU and Andersson, Roland LU (2014) In Scandinavian Journal of Gastroenterology 49(4). p.481-484
Abstract
Abstract Objective. Previous studies have identified a significant volume-outcome relationship for hospitals performing pancreaticoduodenectomy (PD). However, scant information exists concerning the effects of increased caseload of PD within the same hospital. Here, we describe the effects of becoming a high-volume provider of PD. Material and methods. The study group comprised 221 patients who underwent PD between 2000 and 2012. Hospital volume was allocated into three groups: low-volume (<10 PDs/year), years 2000-2004, n = 25; medium-volume (10-24 PDs/year), years 2005-2009, n = 86; and high-volume (≥25 PDs/year), years 2010-2012, n = 110. Results. The annual number of PDs increased from 5 in 2000 to 39 in 2012. The median operative... (More)
Abstract Objective. Previous studies have identified a significant volume-outcome relationship for hospitals performing pancreaticoduodenectomy (PD). However, scant information exists concerning the effects of increased caseload of PD within the same hospital. Here, we describe the effects of becoming a high-volume provider of PD. Material and methods. The study group comprised 221 patients who underwent PD between 2000 and 2012. Hospital volume was allocated into three groups: low-volume (<10 PDs/year), years 2000-2004, n = 25; medium-volume (10-24 PDs/year), years 2005-2009, n = 86; and high-volume (≥25 PDs/year), years 2010-2012, n = 110. Results. The annual number of PDs increased from 5 in 2000 to 39 in 2012. The median operative duration decreased over the volume categories (p < 0.001). Intraoperative blood loss dropped (p < 0.001). The need for intraoperative blood transfusion was reduced (p < 0.001). Increasing hospital volume was associated with fewer reoperations (p = 0.041) and shorter postoperative length of stay (p = 0.010). There was a tendency toward reduced mortality: 4.0% for the low-volume period, 2.3% for the medium-volume period, and 0% for the high-volume period (p = 0.066). Conclusions. The transition from a low- to a high-volume center resulted in optimized outcomes for PD and 0% operative mortality, favoring the continued centralization of this high-risk operation. (Less)
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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
Scandinavian Journal of Gastroenterology
volume
49
issue
4
pages
481 - 484
publisher
Taylor & Francis
external identifiers
  • pmid:24255988
  • wos:000333350100011
  • scopus:84896930007
ISSN
1502-7708
DOI
10.3109/00365521.2013.847116
language
English
LU publication?
yes
id
6b2cb727-2739-4f0a-b79e-cdde1d2d99df (old id 4179110)
alternative location
http://www.ncbi.nlm.nih.gov/pubmed/24255988?dopt=Abstract
date added to LUP
2013-12-02 20:50:03
date last changed
2017-11-05 03:04:59
@article{6b2cb727-2739-4f0a-b79e-cdde1d2d99df,
  abstract     = {Abstract Objective. Previous studies have identified a significant volume-outcome relationship for hospitals performing pancreaticoduodenectomy (PD). However, scant information exists concerning the effects of increased caseload of PD within the same hospital. Here, we describe the effects of becoming a high-volume provider of PD. Material and methods. The study group comprised 221 patients who underwent PD between 2000 and 2012. Hospital volume was allocated into three groups: low-volume (&lt;10 PDs/year), years 2000-2004, n = 25; medium-volume (10-24 PDs/year), years 2005-2009, n = 86; and high-volume (≥25 PDs/year), years 2010-2012, n = 110. Results. The annual number of PDs increased from 5 in 2000 to 39 in 2012. The median operative duration decreased over the volume categories (p &lt; 0.001). Intraoperative blood loss dropped (p &lt; 0.001). The need for intraoperative blood transfusion was reduced (p &lt; 0.001). Increasing hospital volume was associated with fewer reoperations (p = 0.041) and shorter postoperative length of stay (p = 0.010). There was a tendency toward reduced mortality: 4.0% for the low-volume period, 2.3% for the medium-volume period, and 0% for the high-volume period (p = 0.066). Conclusions. The transition from a low- to a high-volume center resulted in optimized outcomes for PD and 0% operative mortality, favoring the continued centralization of this high-risk operation.},
  author       = {Ansari, Daniel and Williamsson, Caroline and Tingstedt, Bobby and Andersson, Bodil and Lindell, Gert and Andersson, Roland},
  issn         = {1502-7708},
  language     = {eng},
  number       = {4},
  pages        = {481--484},
  publisher    = {Taylor & Francis},
  series       = {Scandinavian Journal of Gastroenterology},
  title        = {Pancreaticoduodenectomy - the transition from a low- to a high-volume center.},
  url          = {http://dx.doi.org/10.3109/00365521.2013.847116},
  volume       = {49},
  year         = {2014},
}