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Trends in pancreatic surgery in Switzerland: a survey and nationwide analysis over two decades

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Abstract

Background

Centralisation of highly specialised medicine (HSM) has changed practice and outcome in pancreatic surgery (PS) also in Switzerland. Fewer hospitals are allowed to perform pancreatic surgery according to nationally defined cut-offs.

Objective

We aimed to examine trends in PS in Switzerland. First, to assess opinions and expected trends among Swiss pancreatic surgeons in regard of PS practice and second, to assess the evolution of PS performance in Switzerland by a nationwide retrospective analysis.

Methods

First, a 26-item survey among all surgeons who performed PS in 2016 in Switzerland was performed. Then, nationwide data from 1998 to 2018 from all hospitals performing PS was analysed including centre volume, perioperative morbidity and mortality, surgical indications and utilisation of minimally invasive pancreatic surgery (MIPS). The national cut-off for regulatory accredited volume centres (AVC) was ≥ 12. Additionally, an international benchmark definition for high volume (≥ 20 surgeries/year) was used.

Results

Among 25 surgeons from 15 centres (response rate 51%), the survey revealed agreement that centralisation is important to improve perioperative outcomes. Respondents agreed on a minimum case load per surgeon or centre. Within the nationwide database, 8534 pancreatic resections were identified. Most resections were performed for pancreatic ductal adenocarcinoma (58.9%). There was a significant trend towards centralisation of PS with fewer non-accredited volume centres (nAVC) (36 in 1998 and 17 in 2018, p < 0.001) and more AVC (2 in 1998 and 18 in 2018, p < 0.001). A significantly higher adjusted mortality after pancreatoduodenectomy (PD) was observed in low-volume compared to high-volume hospitals (OR 1.45 [95% CI 1.15–1.84], p = 0.002) and a similar trend compared among AVC and nAVC (OR 1.25 [95% CI 0.98–1.60], p = 0.072), while mortality after distal pancreatectomy (DP) was not influenced by centre volume.

Conclusions

Over the last two decades, centralisation of PS towards higher-volume centres was observed in Switzerland with a decrease of mortality after PD and low mortality after DP. Further centralisation is supported by most pancreatic surgeons. However, the ideal metric and outcome measures for the allocation of highly specialised medicine need further discussion to allow a fair and outcome-focused allocation.

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Data availability

The Swiss Federal Statistical Office’s (BFS, Neuchatel, Switzerland) databases covering the mandatory, nationwide reporting of all stationary hospitalisations (≥ 24 h) in Swiss hospitals starting from 1998 was used for the current analyses. These databases contain anonymised patient-level data including the main diagnosis responsible for hospitalisation and up to 49 secondary diagnoses for comorbidities and complications coded via International Classification of Diseases (ICD-10 German modification) definitions. Procedures are coded by national Swiss surgical classification codes (CHOP), issued annually by the BFS classifying all medical interventions. The national database covering hospitalisations is available from the BFS upon signature of a research and data protection agreement for a fee of 712 Swiss francs. All other data used in this study are freely available under the given links. All codes used for filtering, analyses and graphics are available from the first author upon reasonable request.

Code availability

Not applicable.

Abbreviations

AVC:

Accredited volume centre

CHOP:

Swiss classification of operations

DP:

Distal pancreatectomy

FSO:

Federal Statistical Office of Switzerland

HSM:

Highly specialised medicine

HVC:

High-volume centre

ICD:

International Classification of Diseases

IPMN:

Intraductal papillary mucinous neoplasms

IQR:

Interquartile range

LVC:

Low-volume centre

MIPS:

Minimally invasive pancreatic surgery

nAVC:

Non-accredited volume centre

PD:

Pancreatoduodenectomy

PROMs:

Patient-reported outcome measures

PDAC:

Pancreatic ductal adenocarcinoma

PS:

Pancreatic surgery

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Acknowledgements

We thank Christian Oberkofler and Philipp Müller, both Department of Surgery and Transplantation, University Hospital Zurich, for their help with the design and distribution of the survey.

Funding

This study was supported by the Swiss Pancreas Foundation.

Author information

Author notes

  1. Christoph Kuemmerli and Marcel André Schneider contributed equally to this work.

Authors and Affiliations

  1. Department of Visceral Surgery, Clarunis, University Center for Gastrointestinal and Liver Disease, St. Clara Hospital and University Hospital, Kleinriehenstrasse 30, 4058, Basel, Switzerland

    Christoph Kuemmerli, Martin Bolli & Mathias Worni

  2. Department of Surgery and Transplantation, University Hospital Zurich, Zurich, Switzerland

    Marcel André Schneider & Dominique Lisa Birrer

  3. Department of Visceral Surgery, Lausanne University Hospital CHUV, Lausanne, Switzerland

    Gaëtan-Romain Joliat

  4. Department of Surgery, Geneva University Hospitals, Geneva, Switzerland

    Beat Moeckli

  5. Department of Surgery, Cantonal Hospital of St. Gallen, St. Gallen, Switzerland

    Kristjan Ukegjini

  6. Department of Surgery, Clinic Beau Site, Bern, Switzerland

    Mathias Worni

  7. Swiss Institute for Translational and Entrepreneurial Medicine, Stiftung Lindenhof, Campus SLB, Bern, Switzerland

    Mathias Worni

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  1. Christoph Kuemmerli
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Contributions

Study conception and design: Christoph Kuemmerli, Marcel Schneider, Mathias Worni, Martin Bolli and Dominique Birrer. Acquisition of data: Marcel Schneider, Christoph Kuemmerli and Dominique Birrer. Analysis and interpretation of data: all authors. Drafting of manuscript: Christoph Kuemmerli and Dominique Birrer. Critical revision of manuscript: all authors.

Corresponding author

Correspondence to Christoph Kuemmerli.

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Ethics approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. According to the cantonal ethics committee (BASEC-Nr. Req-2020–00493) all criteria were met, and the waiver of consent granted.

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The authors declare no competing interests.

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Kuemmerli, C., Schneider, M.A., Joliat, GR. et al. Trends in pancreatic surgery in Switzerland: a survey and nationwide analysis over two decades. Langenbecks Arch Surg 407, 3423–3435 (2022). https://doi.org/10.1007/s00423-022-02679-2

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