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Pancreatic Resection Results in a Statewide Surgical Collaborative
Mark A Healy1, Robert W Krell, Zaid M Abdelsattar
1Department of Surgery, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI, USA.
Annals of Surgical Oncology
|March 31, 2015
Summary
Regional surgical collaboratives improve pancreatic surgery outcomes at lower-volume hospitals. Participation in these quality initiatives helps reduce the link between hospital caseload and adverse patient outcomes.
Area of Science:
- Surgical Quality Improvement
- Health Services Research
- Pancreatic Surgery Outcomes
Background:
- A strong association exists between hospital caseload and adverse outcomes for pancreatic resections.
- Regional surgical collaboratives may mitigate the impact of hospital volume on patient outcomes.
- This study examined changes in pancreatectomy outcomes across hospitals with varying caseloads within a statewide collaborative.
Purpose of the Study:
- To investigate temporal changes in adverse outcomes after pancreatectomy.
- To compare outcomes across hospitals with different caseloads (low, medium, high).
- To assess the impact of a statewide surgical collaborative on the volume-outcome relationship.
Main Methods:
- Analysis of 1007 patients undergoing pancreatic resection from 2008-2013 in the Michigan Surgical Quality Collaborative (MSQC).
- Comparison of risk-adjusted rates of major complications, mortality, and failure to rescue between early (2008-2010) and later (2011-2013) periods.
- Stratification of hospitals by caseload (low, medium, high) to evaluate changes in outcome variation.
Main Results:
- Risk-adjusted major complication and mortality rates decreased over time, particularly at low-caseload hospitals.
- Initial disparities in complication and mortality rates between low- and high-caseload hospitals were attenuated in the later period.
- Decreased variation in major complications was primarily driven by improvements in medical complication rates, with less change in surgical-site complications.
Conclusions:
- Lower-volume hospitals participating in regional quality collaboratives can lessen the volume-outcome relationship in pancreatic surgery.
- Continued collaborative efforts focusing on technical and intraoperative care can further enhance the quality of pancreatic surgery.
- Quality collaboratives are effective in improving surgical outcomes, especially for lower-volume centers.
