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. 2019 Sep;43(9):2290-2299.
doi: 10.1007/s00268-019-05019-6.

Prophylactic Pancreatectomies Carry Prohibitive Mortality at Low-Volume Centers: A California Cancer Registry Study

Ann Falor Callahan  1 , Philip H G Ituarte  2 , Leanne Goldstein  2 , Susanne G Warner  1 , Yanghee Woo  1 , Gagandeep Singh  1 , Yuman Fong  1 , Laleh G Melstrom  3
Affiliations

Prophylactic Pancreatectomies Carry Prohibitive Mortality at Low-Volume Centers: A California Cancer Registry Study

Ann Falor Callahan et al. World J Surg. 2019 Sep.

Abstract

Background: Pancreatectomy for malignancy is associated with improved outcomes when performed at high-volume centers. The goal of this study was to assess pancreatectomy outcomes for premalignant cystic lesions as a function of hospital volume.

Methods: The Healthcare Cost and Utilization Project (HCUP) was queried for all pancreatectomies performed in California from 2003 to 2011. Cases were stratified, separating benign versus malignant disease. Hospitals were categorized as low-volume (≤25 pancreatectomies/year; LV) or high-volume (>25; HV) centers. Perioperative morbidity, mortality, and length of stay were compared in HV vs. LV centers.

Results: There were 7554 pancreatectomies performed in 201 hospitals during the study period, where 5652 (75%) procedures were performed for malignancy, 338 (4%) for chronic pancreatitis, and 1564 (21%) for benign/premalignant cysts. The majority of pancreatectomies for cystic disease were performed at LV centers (65%). There were no significant differences in length of stay (7 vs. 8 days; p = 0.6) or 90-day readmission rates (12.8% vs. 12.9%; p = 1.0) in HV versus LV centers. However, there were higher surgical (46.2% LV vs. 41.1% HV, p = 0.05) and medical (13.3% LV vs. 9.2% HV; p = 0.017) complications at LV centers. Most importantly, there was a fourfold higher in-hospital mortality at LV centers (2.36% vs. 0.55%; p = 0.007).

Conclusion: Pancreatic resection for benign lesions at HV hospitals is associated with significantly lower morbidity and mortality, suggesting that when feasible, patients should seek care at high-volume centers for these semi-elective surgeries.

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Figures

Figure 1.
Figure 1.
Flowchart of patients who underwent pancreatic resections (n=7,554). Patients were excluded for islet cell neoplasms (n=73), pancreatic cancer (n=5,566) and chronic pancreatitis (n=338). The final cohort of patients had pancreatectomy performed for benign disease (n=1,564).
Figure 2.
Figure 2.
Surgical Complications for patients undergoing distal pancreatectomy (a) and pancreaticoduodenectomy (b) for benign lesions of the pancreas in HV (>25/year) and LV (<25/year) centers.
Figure 3.
Figure 3.
Medical Complications for patients undergoing distal pancreatectomy (a) and pancreaticoduodenectomy (b) for benign lesions of the pancreas in HV (>25/year) and LV (<25/year) centers.
See this image and copyright information in PMC

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