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Volume-outcome relationship in pancreatic surgery
G Alsfasser1, H Leicht2, C Günster2
1Department of General, Thoracic, Vascular and Transplantation Surgery, University of Rostock, Rostock, Germany.
The British Journal of Surgery
|October 28, 2015
Summary
High-volume hospitals in Germany showed lower 1-year mortality rates for pancreatic surgery patients. This volume-outcome relationship highlights the importance of center expertise for surgical success and patient survival.
Area of Science:
- Surgical outcomes research
- Health services research
- Public health
Background:
- Volume-outcome relationships are crucial in major surgery.
- Discharge data alone may not fully capture surgical outcomes.
- Considering transfers and later events provides a more complete picture.
Purpose of the Study:
- To assess the volume-outcome relationship in pancreatic surgery.
- To analyze the impact of hospital volume on patient mortality.
- To evaluate outcomes beyond initial discharge.
Main Methods:
- Utilized German claims data (2008-2010) for pancreatic surgery patients.
- Employed logistic regression models with random effects.
- Analyzed 1-year, 90-day, and in-hospital mortality based on hospital volume quintiles, adjusting for patient factors.
Main Results:
- Significantly higher 1-year mortality in lower-volume centers compared to the highest-volume quintile.
- Similar, though less pronounced, effects observed for in-hospital and 90-day mortality.
- The impact of hospital volume on 1-year mortality was comparable to that of comorbidities like renal failure.
Conclusions:
- Pancreatic surgery mortality is multifactorial.
- Higher volume centers in Germany demonstrated reduced 1-year mortality.
- This underscores the importance of hospital volume in pancreatic surgery outcomes.
