Annals of Surgical Oncology

, Volume 9, Issue 9, pp 847–854

National estimates of mortality rates for radical pancreaticoduodenectomy in 25,000 patients

  • Cyrus A. Kotwall
  • J. Gary Maxwell
  • Carda C. Brinker
  • Gary G. Koch
  • Deborah L. Covington
Original Articles

DOI: 10.1007/BF02557520

Cite this article as:
Kotwall, C.A., Maxwell, J.G., Brinker, C.C. et al. Annals of Surgical Oncology (2002) 9: 847. doi:10.1007/BF02557520

Abstract

Background

Recent publications suggest an inverse relationship between mortality rates in the Whipple procedure for periampullary cancer and hospital volume/teaching status.

Methods

The Nationwide Inpatient Sample database from 1988 to 1995, containing 24,926 patients undergoing pancreatectomy for periampullary cancer, was used.

Results

The mean number of procedures per hospital per year was 1.5, and the overall mortality was 14%. The volume of procedures per year increased from the rural to the urban nonteaching hospitals to the urban teaching hospitals (.6, 1.1, and 2.7, respectively), with a steady decrease in mortality among the three hospital types (18%, 15%, and 11%). A multiple logistic regression model with mortality odds ratios (ORs) showed that male sex (OR, 1.3), increasing age (OR, 1.6 to 6.7 in decades from 50 to≥80 vs.<50 years), emergency admission (OR, 1.5), and hospital volume (less than one vs. one or more cases per year; OR, 1.5) were significantly predictive for increased in-hospital mortality.

Conclusions

In-hospital mortality in the low-volume hospital setting is prohibitive, and review of each institution's mortality rates must occur before these procedures are performed in those institutions. In addition, patients over the age of 60 years, male patients, and those with an urgent admission are at a significant risk of in-hospital death, and consideration should be given toward transfer to an experienced institution.

Key Words

Mortality rateWhipple procedurePancreaticoduodenectomyHospital volume

Copyright information

© The Society of Surgical Oncology, Inc 2002

Authors and Affiliations

  • Cyrus A. Kotwall
    • 1
    • 2
    • 3
  • J. Gary Maxwell
    • 1
    • 2
    • 3
  • Carda C. Brinker
    • 1
  • Gary G. Koch
    • 3
  • Deborah L. Covington
    • 3
  1. 1.Coastal Area Health Education CenterWilmington
  2. 2.New Hanover Health NetworkWilmington
  3. 3.University of North Carolina-Chapel HillChapel Hill