Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 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.

PubMed Disclaimer

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

References

    1. Tanaka M, Fernandez-del Castillo C, Adsay V, Chari S, Falconi M, Jang JY, Kimura W, Levy P, Pitman MB, Schmidt CM, Shimizu M, Wolfgang CL, Yamaguchi K, Yamao K, International Association of P. International Consensus Guidelines 2012 for the Management of IPMN and MCN of the Pancreas. Pancreatology 2012;12(3): 183–197. - PubMed
    1. Farrell J, Fernandez-del Castillo C. Pancreatic Cystic Neoplasms: Management and Unanswered Questions. Gastroenterology 2013;144: 1303–1315. - PubMed
    1. Cameron JL, Riall TS, Coleman J, Belcher KA. One Thousand Consecutive Pancreaticoduodenectomies. Ann Surg 2006;244(1): 10–15. - PMC - PubMed
    1. Lau K, Salami A, Barden G, Khawja S, Castillo DL, Poppelaars V, Artinyan A, Awad SS, Berger DH, Albo D, Anaya DA. The effect of a regional hepatopancreaticobiliary surgical program on clinical volume, quality of cancer care, and outcomes in the Veterans Affairs system. JAMA Surg 2014;149(11): 1153–1161. - PubMed
    1. Khuri SF, Daley J, Henderson W, Hur K, Hossain M, Soybel D, Kizer KW, Aust JB, Bell RH Jr., Chong V, Demakis J, Fabri PJ, Gibbs JO, Grover F, Hammermeister K, McDonald G, Passaro E Jr., Phillips L, Scamman F, Spencer J, Stremple JF. Relation of surgical volume to outcome in eight common operations: results from the VA National Surgical Quality Improvement Program. Ann Surg 1999;230(3): 414–429; discussion 429–432. - PMC - PubMed

Publication types