The Effect of Hospital versus Surgeon Volume on Short Term Patient Outcomes after Pancreaticoduodenectomy: A SEER-Medicare Analysis
Marianna V. Papageorge, MD1, Susanna W.L. de Geus, MD, PhD1, Alison P. Woods, MD1,2, Sing Chau Ng, MS1, David McAneny, MD,1 Jennifer F. Tseng, MD, MPH1, Kelly Kenzik PhD1,3, Teviah E. Sachs, MD, MPH1
1Department of Surgery, Boston Medical Center, Boston University School of Medical, Boston, MA; 2Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; 3Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL
The volume-outcome relationship has been well-established for pancreaticoduodenectomy (PD). It remains unclear if this is primarily driven by hospital volume or individual surgeon experience. The aim of this study was to determine the relationship of hospital and surgeon volume on short-term outcomes in patients with pancreatic adenocarcinoma undergoing PD.
Patients >65 years old who underwent PD for pancreatic adenocarcinoma were identified from SEER-Medicare (2008-2015). Analyses were stratified by hospital and surgeon volume and four volume cohorts were created: low-low (low hospital, low surgeon), low-high (low hospital, high surgeon), high-low (high hospital, low surgeon), high-high (high hospital, high surgeon). Propensity scores were created for the odds of undergoing surgery with high volume surgeons. Following matching, multivariate analysis was used to assess the impact of surgeon volume on outcomes.
In total, 2450 patients were identified of which 54.3% were treated at high volume hospitals (40.0% low volume surgeons, 60.0% high volume surgeons) and 45.7% were treated at low volume hospitals (45.7% low volume surgeons, 54.3% high volume surgeons). On matched multivariate analysis, there were no significant differences in the risk of major complications, 90-day mortality and 30-day readmission based on surgeon volume within the low and high hospital volume cohorts.
As compared to surgeon volume, hospital volume is a more significant factor in predicting short-term outcomes after PD. This suggests that a focus on resources and care pathways, in combination with volume metrics, is more likely to achieve high-quality care for patients undergoing PD across all hospitals.
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