Skip to main content
PMC home page
The Western Journal of Medicine logoLink to The Western Journal of Medicine
. 1996 Nov;165(5):294–300.

Hospital volume influences outcome in patients undergoing pancreatic resection for cancer.

R E Glasgow 1, S J Mulvihill 1
PMCID: PMC1303846  PMID: 8993200

Abstract

Surgical resection is the only possibly curative treatment of malignant pancreatic neoplasms, but major pancreatic resection for cancer is associated with high rates of morbidity and mortality. The objective of this study was to determine the relation between hospital volume and outcome in patients undergoing pancreatic resection for malignancy in California. Data were obtained from reports submitted to the Office of Statewide Health Planning and Development by all California hospitals from 1990 through 1994. Patient abstracts were analyzed for each of 1,705 patients who underwent major pancreatic resection for malignancy. Of the 298 reporting hospitals, 88% treated fewer than 2 patients per year; these low-volume centers treated the majority of patients. High-volume providers had significantly decreased operative mortality, complication-associated mortality, patient resource use, and total charges and were more likely than low-volume centers to discharge patients to home. These differences were not accounted for by patient mix. This study supports the concept of regionalizing high risk procedures in general surgery, such as major pancreatic resection for cancer.

Full text

PDF

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Aston S. J., Longmire W. P., Jr Pancreaticoduodenal resection. Twenty years' experience. Arch Surg. 1973 Jun;106(6):813–817. doi: 10.1001/archsurg.1973.01350180047015. [DOI] [PubMed] [Google Scholar]
  2. Boring C. C., Squires T. S., Tong T., Montgomery S. Cancer statistics, 1994. CA Cancer J Clin. 1994 Jan-Feb;44(1):7–26. doi: 10.3322/canjclin.44.1.7. [DOI] [PubMed] [Google Scholar]
  3. Cameron J. L., Pitt H. A., Yeo C. J., Lillemoe K. D., Kaufman H. S., Coleman J. One hundred and forty-five consecutive pancreaticoduodenectomies without mortality. Ann Surg. 1993 May;217(5):430–438. doi: 10.1097/00000658-199305010-00002. [DOI] [PMC free article] [PubMed] [Google Scholar]
  4. Crist D. W., Sitzmann J. V., Cameron J. L. Improved hospital morbidity, mortality, and survival after the Whipple procedure. Ann Surg. 1987 Sep;206(3):358–365. doi: 10.1097/00000658-198709000-00014. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Fowles J., Bunker J. P., Schurman D. J. Hip surgery data yield quality indicators. Bus Health. 1987 Jun;4(8):44–46. [PubMed] [Google Scholar]
  6. Geer R. J., Brennan M. F. Prognostic indicators for survival after resection of pancreatic adenocarcinoma. Am J Surg. 1993 Jan;165(1):68–73. doi: 10.1016/s0002-9610(05)80406-4. [DOI] [PubMed] [Google Scholar]
  7. Gordon T. A., Burleyson G. P., Tielsch J. M., Cameron J. L. The effects of regionalization on cost and outcome for one general high-risk surgical procedure. Ann Surg. 1995 Jan;221(1):43–49. doi: 10.1097/00000658-199501000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Grace P. A., Pitt H. A., Tompkins R. K., DenBesten L., Longmire W. P., Jr Decreased morbidity and mortality after pancreatoduodenectomy. Am J Surg. 1986 Jan;151(1):141–149. doi: 10.1016/0002-9610(86)90024-3. [DOI] [PubMed] [Google Scholar]
  9. Green J., Wintfeld N., Sharkey P., Passman L. J. The importance of severity of illness in assessing hospital mortality. JAMA. 1990 Jan 12;263(2):241–246. [PubMed] [Google Scholar]
  10. Grumbach K., Anderson G. M., Luft H. S., Roos L. L., Brook R. Regionalization of cardiac surgery in the United States and Canada. Geographic access, choice, and outcomes. JAMA. 1995 Oct 25;274(16):1282–1288. [PubMed] [Google Scholar]
  11. Hannan E. L., O'Donnell J. F., Kilburn H., Jr, Bernard H. R., Yazici A. Investigation of the relationship between volume and mortality for surgical procedures performed in New York State hospitals. JAMA. 1989 Jul 28;262(4):503–510. [PubMed] [Google Scholar]
  12. Horbar J. D., Leahy K. A. An assessment of data quality in the Vermont-Oxford Trials Network database. Control Clin Trials. 1995 Feb;16(1):51–61. doi: 10.1016/0197-2456(94)00019-y. [DOI] [PubMed] [Google Scholar]
  13. Hughes R. G., Garnick D. W., Luft H. S., McPhee S. J., Hunt S. S. Hospital volume and patient outcomes. The case of hip fracture patients. Med Care. 1988 Nov;26(11):1057–1067. doi: 10.1097/00005650-198811000-00004. [DOI] [PubMed] [Google Scholar]
  14. Janes R. H., Jr, Niederhuber J. E., Chmiel J. S., Winchester D. P., Ocwieja K. C., Karnell J. H., Clive R. E., Menck H. R. National patterns of care for pancreatic cancer. Results of a survey by the Commission on Cancer. Ann Surg. 1996 Mar;223(3):261–272. doi: 10.1097/00000658-199603000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Jonasson O., Kwakwa F., Sheldon G. F. Calculating the workforce in general surgery. JAMA. 1995 Sep 6;274(9):731–734. [PubMed] [Google Scholar]
  16. Laffel G. L., Barnett A. I., Finkelstein S., Kaye M. P. The relation between experience and outcome in heart transplantation. N Engl J Med. 1992 Oct 22;327(17):1220–1225. doi: 10.1056/NEJM199210223271707. [DOI] [PubMed] [Google Scholar]
  17. Lansing P. B., Blalock J. B., Ochsner J. L. Pancreatoduodenectomy: a retrospective review 1949 to 1969. Am Surg. 1972 Feb;38(2):79–86. [PubMed] [Google Scholar]
  18. Lieberman M. D., Kilburn H., Lindsey M., Brennan M. F. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg. 1995 Nov;222(5):638–645. doi: 10.1097/00000658-199511000-00006. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Lloyd S. S., Rissing J. P. Physician and coding errors in patient records. JAMA. 1985 Sep 13;254(10):1330–1336. [PubMed] [Google Scholar]
  20. Luft H. S., Bunker J. P., Enthoven A. C. Should operations be regionalized? The empirical relation between surgical volume and mortality. N Engl J Med. 1979 Dec 20;301(25):1364–1369. doi: 10.1056/NEJM197912203012503. [DOI] [PubMed] [Google Scholar]
  21. Pellegrini C. A., Heck C. F., Raper S., Way L. W. An analysis of the reduced morbidity and mortality rates after pancreaticoduodenectomy. Arch Surg. 1989 Jul;124(7):778–781. doi: 10.1001/archsurg.1989.01410070028006. [DOI] [PubMed] [Google Scholar]
  22. Showstack J. A., Rosenfeld K. E., Garnick D. W., Luft H. S., Schaffarzick R. W., Fowles J. Association of volume with outcome of coronary artery bypass graft surgery. Scheduled vs nonscheduled operations. JAMA. 1987 Feb 13;257(6):785–789. [PubMed] [Google Scholar]
  23. Trede M., Schwall G., Saeger H. D. Survival after pancreatoduodenectomy. 118 consecutive resections without an operative mortality. Ann Surg. 1990 Apr;211(4):447–458. doi: 10.1097/00000658-199004000-00011. [DOI] [PMC free article] [PubMed] [Google Scholar]
  24. Wade T. P., el-Ghazzawy A. G., Virgo K. S., Johnson F. E. The Whipple resection for cancer in U.S. Department of Veterans Affairs Hospitals. Ann Surg. 1995 Mar;221(3):241–248. doi: 10.1097/00000658-199503000-00005. [DOI] [PMC free article] [PubMed] [Google Scholar]

Articles from Western Journal of Medicine are provided here courtesy of BMJ Publishing Group

RESOURCES