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Huerta CT, Collier AL, Hernandez AE, Rodriguez C, Shah A, Kronenfeld JP, Franceschi DF, Sleeman D, Livingstone AS, Thorson CM. Nationwide Outcomes of Pancreaticoduodenectomy for Pancreatic Malignancies: Center Volume Matters. Am Surg 2023; 89:6020-6029. [PMID: 37310685 PMCID: PMC10883718 DOI: 10.1177/00031348231184198] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
BACKGROUND Complex surgeries such as pancreaticoduodenectomies (PD) have been shown to have better outcomes when performed at high-volume centers (HVCs) compared to low-volume centers (LVCs). Few studies have compared these factors on a national level. The purpose of this study was to analyze nationwide outcomes for patients undergoing PD across hospital centers with different surgical volumes. METHODS The Nationwide Readmissions Database (2010-2014) was queried for all patients who underwent open PD for pancreatic carcinoma. High-volume centers were defined as hospitals where 20 or more PDs were performed per year. Sociodemographic factors, readmission rates, and perioperative outcomes were compared before and after propensity score-matched analysis (PSMA) for 76 covariates including demographics, hospital factors, comorbidities, and additional diagnoses. Results were weighted for national estimates. RESULTS A total of 19,810 patients were identified with age 66 ± 11 years. There were 6,840 (35%) cases performed at LVCs, and 12,970 (65%) at HVCs. Patient comorbidities were greater in the LVC cohort, and more PDs were performed at teaching hospitals in the HVC cohort. These discrepancies were controlled for with PSMA. Length of stay (LOS), mortality, invasive procedures, and perioperative complications were greater in LVCs when compared to HVCs before and after PSMA. Additionally, readmission rates at one year (38% vs 34%, P < .001) and readmission complications were greater in the LVC cohort. CONCLUSIONS Pancreaticoduodenectomy is more commonly performed at HVCs, which is associated with less complications and improved outcomes compared to LVCs.
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Affiliation(s)
| | - Amber L Collier
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL, USA
| | | | - Cindy Rodriguez
- Florida State University College of Medicine, Tallahassee, FL, USA
| | - Ankit Shah
- University of Miami Miller School of Medicine, Miami, FL, USA
| | - Joshua P Kronenfeld
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL, USA
| | - Dido F Franceschi
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL, USA
- Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Danny Sleeman
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL, USA
- Division of General Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Alan S Livingstone
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL, USA
- Division of Surgical Oncology, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Chad M Thorson
- DeWitt Daughtry Family Department of Surgery, University of Miami, Miami, FL, USA
- Division of Pediatric Surgery, University of Miami Miller School of Medicine, Miami, FL, USA
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