Regional differences for the risk of in-hospital mortality after pancreaticoduodenectomy: a cross-sectional study
Teruchika Koyama1,2, Nobutoshi Nawa3, Hisaaki Nishimura1
1Department of Public Health, Institute of Science Tokyo, 1-5-45 Yushima, Bunkyo-KuTokyo, 113-8510, Japan.
Background:
Pancreaticoduodenectomy is the only curative treatment for pancreatic cancer, though it is an invasive procedure, with a high perioperative mortality rate, which may differ by region. The objectives of this study are to 1) investigate the risk of in-hospital mortality after pancreaticoduodenectomy in urban and rural hospitals, and 2) investigate its differences, stratified by age groups and hospital volume.
Methods:
This study analyzed data from 86,339 patients who underwent pancreaticoduodenectomy from a Japanese nationwide database between 2010 and 2021. Hospitals were classified as urban if located in cities with ≥ 500,000 residents or in municipalities where ≥ 1.5% of residents commute to such cities, and all others were classified as rural. The primary outcome was in-hospital mortality within 90 days after pancreaticoduodenectomy. Logistic regression was applied.
Results:
The risk for in-hospital mortality within 90 days after pancreaticoduodenectomy was significantly higher for patients in rural hospitals than those in urban hospitals (OR 1.17 [1.04-1.31]). Stratified analysis by age groups showed rural location was a significantly higher risk for patients ≧80 years old (OR 1.41 [1.11-1.80]), whereas there was no significant difference among patients aged ≤ 79 years. Stratified analysis by hospital volume and age groups showed that rural location was a significantly higher risk for patients ≧80 years old in low-volume hospitals (OR 1.43 [1.09-1.87]), whereas that was not significant for patients in high-volume hospitals.
Conclusions:
The risk for in-hospital mortality was higher for rural hospitals than urban. Patients aged ≥ 80 years old in low-volume rural hospitals represented the highest-risk subgroup.
