Improvement in Surgical Quality Following Pancreaticoduodenectomy With Increasing Case Volume in a Rural Hospital

Area of Science:

• Surgical outcomes research
• Health services research
• Pancreatic surgery

Background:

• Centralization of complex surgical care to high-volume centers is supported by existing literature.
• The relationship between surgical volume and quality outcomes is a critical area of study.
• Pancreaticoduodenectomy (PD) is a complex procedure where volume-outcome relationships are particularly relevant.

Purpose of the Study:

• To evaluate the impact of increasing surgical volume on quality benchmarks for pancreaticoduodenectomy (PD) at a rural hospital.
• To chronicle improvements in PD quality as a center matures from low to very high volume.
• To assess changes in length of stay, readmissions, mortality, survival, and lymph node yield with increasing institutional experience.

Main Methods:

• Retrospective review of a prospective pancreatic surgery database (July 2007 - June 2020).
• Categorization of annual surgical volume into low (≤12/year), high (13-29/year), and very high (≥30/year).
• Comparison of quality metrics including LOS, 30-day readmissions/mortality, 1- and 3-year survival, margin status, and lymph node harvest.

Main Results:

• 375 PDs were performed; 62.1% for ductal adenocarcinoma.
• Significant reductions in length of stay (LOS) and 30-day readmissions were observed as volume increased.
• No significant differences in 30-day mortality, 1- or 3-year survival, or margin negativity rates were associated with volume.
• Lymph node harvest significantly improved with increased institutional experience.

Conclusions:

• A rural hospital's pancreatic surgery program demonstrated rapid maturation from low to very high volume.
• Increased surgical volume correlated with improved operational efficiencies and enhanced surgical quality metrics (LOS, readmissions).
• Patient survival rates were primarily influenced by biological factors rather than surgical volume alone.