The Impact of Hospital Mergers: Exploring the Importance of Flagship Designation, Hospital Volume, and Surgeon Volume...

The proportion of free-standing hospitals is rapidly declining in favor of healthcare systems. We aim to compare outcomes after pancreatoduodenectomy (PD) between hospital volume and surgeon volume within consolidated healthcare systems.

Utilizing New York State's SPARCS database, we identified adults undergoing PD (2016-2019) at flagship (highest volume within a system) or non-flagship hospitals. Analysis compared 30- and 90-day outcomes by hospital and surgeon annual volume (hospital volume ≥ 20 vs < 20PD/yr and surgical volume ≥ 10 vs < 10PD/yr). We controlled for patient self-selection across surgeons and facilities using propensity-score matching.

Among 1633 patients, 68.8% were treated at flagship hospitals. Compared to patients treated at non-flagship hospitals, those at flagship hospitals had lower median postoperative length of stay (8-days vs. 10-days, p < 0.01), fewer transfusions (17% vs 29%, p < 0.01), other post-procedural (8.1% vs 12.6%, p = 0.02), and overall complications (53% vs 59%, p = 0.07). The lowest overall complications and length of stay (p < 0.05) were observed at high-volume hospitals regardless of surgeon volume.

More favorable outcomes among pancreatoduodenectomy patient were observed at high-volume flagship hospitals. When planning a complex surgery, patients should be referred to the highest volume hospital within their healthcare system to optimize post-operative outcomes.