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Postoperative pancreatic fistula-impact on outcome, hospital cost and effects of centralization

Williamsson, Caroline LU ; Ansari, Daniel LU ; Andersson, Roland LU and Tingstedt, Bobby LU (2017) In HPB 19(5). p.436-442
Abstract

Background: One of the most serious complications after pancreaticoduodenectomy (PD) is postoperative pancreatic fistula (POPF). This study investigated the incidence of POPF before and after centralization of pancreatic surgery in Southern Sweden and its impact on outcome and health care costs. Methods: The local registry comprising all pancreatic resections at Skåne University Hospital, Lund, Sweden, was searched for PDs from 2005 to 2015. The patients were analysed in three groups: low-volume, high-volume and after introduction of an enhanced recovery program. Only the clinically relevant POPF grades B and C (CR-POPF) were investigated. Results: 322 consecutive patients were identified. The annual operation volume increased almost... (More)

Background: One of the most serious complications after pancreaticoduodenectomy (PD) is postoperative pancreatic fistula (POPF). This study investigated the incidence of POPF before and after centralization of pancreatic surgery in Southern Sweden and its impact on outcome and health care costs. Methods: The local registry comprising all pancreatic resections at Skåne University Hospital, Lund, Sweden, was searched for PDs from 2005 to 2015. The patients were analysed in three groups: low-volume, high-volume and after introduction of an enhanced recovery program. Only the clinically relevant POPF grades B and C (CR-POPF) were investigated. Results: 322 consecutive patients were identified. The annual operation volume increased almost threefold and the postoperative length of stay and total hospital cost decreased concurrently. The incidence of CR-POPF did not decrease over time. The group with CR-POPF had more complications and prolonged length of stay. The cost was 1.5 times higher for patients with CR-POPF and the cost did not decline despite the increase of hospital volume. Conclusion: Centralization of pancreatic surgery did not decrease the rate of CR-POPF nor its subsequent impact on LOS and costs. Further efforts must be made to reduce the incidence of CR-POPF.

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author
organization
publishing date
type
Contribution to journal
publication status
published
subject
in
HPB
volume
19
issue
5
pages
436 - 442
publisher
Informa Healthcare
external identifiers
  • scopus:85011101735
  • wos:000400588900009
ISSN
1365-182X
DOI
10.1016/j.hpb.2017.01.004
language
English
LU publication?
yes
id
ecbe7323-b269-42be-8b4c-5213071091b6
date added to LUP
2017-02-17 12:54:14
date last changed
2018-10-07 04:53:05
@article{ecbe7323-b269-42be-8b4c-5213071091b6,
  abstract     = {<p>Background: One of the most serious complications after pancreaticoduodenectomy (PD) is postoperative pancreatic fistula (POPF). This study investigated the incidence of POPF before and after centralization of pancreatic surgery in Southern Sweden and its impact on outcome and health care costs. Methods: The local registry comprising all pancreatic resections at Skåne University Hospital, Lund, Sweden, was searched for PDs from 2005 to 2015. The patients were analysed in three groups: low-volume, high-volume and after introduction of an enhanced recovery program. Only the clinically relevant POPF grades B and C (CR-POPF) were investigated. Results: 322 consecutive patients were identified. The annual operation volume increased almost threefold and the postoperative length of stay and total hospital cost decreased concurrently. The incidence of CR-POPF did not decrease over time. The group with CR-POPF had more complications and prolonged length of stay. The cost was 1.5 times higher for patients with CR-POPF and the cost did not decline despite the increase of hospital volume. Conclusion: Centralization of pancreatic surgery did not decrease the rate of CR-POPF nor its subsequent impact on LOS and costs. Further efforts must be made to reduce the incidence of CR-POPF.</p>},
  author       = {Williamsson, Caroline and Ansari, Daniel and Andersson, Roland and Tingstedt, Bobby},
  issn         = {1365-182X},
  language     = {eng},
  number       = {5},
  pages        = {436--442},
  publisher    = {Informa Healthcare},
  series       = {HPB},
  title        = {Postoperative pancreatic fistula-impact on outcome, hospital cost and effects of centralization},
  url          = {http://dx.doi.org/10.1016/j.hpb.2017.01.004},
  volume       = {19},
  year         = {2017},
}