Hospital Volume and Health Equity in Whipple Surgery: Who Is Left Behind

BackgroundPancreaticoduodenectomy (PD) is a complex surgery that often has the best outcomes at high-volume centers. The influence of neighborhood socioeconomic status and location of care is poorly studied. This study aims to evaluate the relationship between hospital volume, patient outcomes, and socioeconomic disparities.MethodsWe utilized a statewide hospital discharge database from Pennsylvania (2017-2021) to analyze 1316 PD cases. Hospitals were categorized by volume based on the total number of cases performed in the 5-year study period. Multivariable logistic regression was employed to assess mortality, 30-day readmission, and non-routine discharge, adjusting for patient demographics, hospital characteristics, and Distressed Communities Index (DCI) scores.ResultsPatients in lowest-volume hospitals are more likely to live in distressed communities compared to those in medium- and higher-volume hospitals. Outcomes were similar between medium- and higher-volume hospitals for mortality (AOR = 0.578, P = 0.472), readmission (AOR = 1.118, P = 0.666), and non-routine discharge (AOR = 1.249, P = 0.289). Among patients from distressed communities, there were no significant differences in mortality, readmission, or non-routine discharge between medium- and higher-volume hospitals (all P > 0.4). The travel distance between a lowest- vs medium-volume hospital is not substantially different.ConclusionsUrban distressed patients are close to medium-volume centers but disproportionately go to lowest-volume centers with worse outcomes. Medium-volume hospitals provide clinical outcomes for PD surgery that are comparable to those of higher-volume hospitals and should serve as a viable alternative for patients from distressed communities who face access barriers to high-volume centers.