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Updated: Feb 3, 2026

Application of End-to-end Anastomosis in Robotic Central Pancreatectomy
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Hospital volume stratification using stratum-specific likelihood ratios for pancreatectomy.

Kristen N Kaiser1, Alexa J Hughes1, Brian M Ruedinger1

  • 1Department of Surgery, Surgical Outcomes and Quality Improvement Center, Indiana University School of Medicine, Indianapolis, IN, United States.

Journal of Gastrointestinal Surgery : Official Journal of the Society for Surgery of the Alimentary Tract
|February 1, 2026
PubMed
Summary

Stratum specific likelihood ratios (SSLR) reveal that higher pancreatectomy volumes are linked to better patient outcomes, even in recent data. This suggests the volume-outcome relationship persists, contrary to some previous findings.

Keywords:
Hospital volumePancreatectomyVolume-outcome relationship

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Area of Science:

  • Surgical Oncology
  • Health Services Research
  • Biostatistics

Background:

  • Recent literature questions the volume-outcome relationship in pancreatectomy due to perceived attenuation.
  • This perceived attenuation may stem from methodological limitations of single, binary volume cutoffs.
  • Stratum specific likelihood ratios (SSLR) offer a method to define empirical volume strata and detect persistent gradients.

Purpose of the Study:

  • To define volume strata for pancreatectomy using SSLR.
  • To assess the robustness of these strata across multiple outcomes.
  • To examine the persistence of the volume-outcome association in modern surgical cohorts.

Main Methods:

  • Utilized the National Cancer Database to identify patients undergoing pancreatectomy (2004-2021).
  • Defined volume strata using SSLR based on 90-day postoperative mortality.
  • Assessed temporal threshold stability via stratified outcome analysis (chi-squared).

Main Results:

  • Analyzed 61,920 pancreatectomies across 982 facilities; 90-day mortality was 5.4%.
  • SSLR identified six volume strata (≤3 to ≥121 procedures/year) with decreasing mortality (11% to 2.3%; p<0.001).
  • An optimized threshold of 21 procedures/year was identified; volume-outcome associations persisted across temporal strata (p<0.001).

Conclusions:

  • SSLR demonstrates a persistent volume-outcome association for pancreatectomy, even with contemporary data.
  • The findings indicate that previous reports of attenuated relationships may be due to limitations of static, binary cutoffs.
  • Empirically derived volume strata are crucial for accurately assessing the volume-outcome relationship in complex surgical procedures.