Temporal and Geographic Trends and Outcomes of Surgical Procedures for Diseases of the Pancreas in New York State.

摘要

Aim: Pancreatic resection is performed for a wide range of malignant (e.g., pancreatic cancer) and non-malignant indications (e.g., traumatic injury and cysts). This research aims to determine the volume-outcome relationship between hospital volume and surgeon volume with in-hospital mortality as well as to determine the temporal trends in utilization of the three most commonly used pancreatectomy procedures (Whipple, distal pancreatectomy and total pancreatectomy). The study also indirectly determines the regionalization of pancreatectomy procedures in New York State.;Hypothesis: There is an effect of hospital and surgeon volume on in-hospital mortality.;Methods: Inpatient administrative data from the New York Statewide Planning and Research Cooperative System (SPARCS) was utilized to identify cases of pancreatic surgery based on ICD-9-CM procedure codes from 1999-2014. Patients aged 18 years and over were eligible for inclusion in the analysis. Multivariate logistic regression models were utilized to identify the effect of independent predictors on in-hospital mortality as well to determine the effect of confounding (demographic, clinical and time period) factors on the independent predictors. For temporal trend analyses, age-sex standardized rates were calculated to determine utilization of the pancreatectomy procedures. Percentage of patients travelling outside their health service area to receive a pancreatectomy procedure was calculated to determine regionalization.;Results: Of the 18,305 pancreatectomy hospitalizations, 16,629 were selected for regression analysis. The odds of in-hospital mortality were 2.37 times higher in low volume and 1.94 times higher in medium volume hospitals compared to high volume hospitals after controlling for demographic, clinical and time variables. Similarly the odds of in-hospital mortality were found to be 3.72 times higher for very low volume surgeons, 2.50 times higher for low volume surgeons, and 1.62 times higher for medium volume surgeons compared to high volume surgeons after controlling for demographic, clinical and time variables in New York State. These results were statistically significant (p < .0001). Also high volume surgeons in high volume hospitals showed improved outcomes (lower in-hospital mortality) compared to other hospital-surgeon combinations.;Conclusion: An increase in hospital and surgeon volume decreases the in-hospital mortality associated with a pancreatectomy procedure in New York State.