Journal of Gastrointestinal Surgery

, Volume 12, Issue 3, pp 442–449 | Cite as

Frequency With Which Surgeons Undertake Pancreaticoduodenectomy Continues to Determine Length of Stay, Hospital Charges, and In-Hospital Mortality

  • Alexander RosemurgyEmail author
  • Sarah Cowgill
  • Brian Coe
  • Ashley Thomas
  • Sam Al-Saadi
  • Steven Goldin
  • Emmanuel Zervos
ahpba annual meeting



This study was undertaken to determine changes in the frequency of, volume of, and outcomes after pancreaticoduodenectomy 6 years after a study denoted that, in Florida, the frequency and volume of pancreaticoduodenectomy impacted outcome.


Using the State of Florida Agency for Health Care Administration database, the frequency and volume of pancreaticoduodenectomy was correlated with average length of hospital stay (ALOS), in-hospital mortality, and hospital charges for identical periods in 1995–1997 and 2003–2005.


Compared to 1995–1997, 88% more pancreaticoduodenectomy was performed in 2003–2005 by 6% fewer surgeons; the majority of pancreaticoduodenectomies were conducted by surgeons doing <1 pancreaticoduodenectomy every 2 months. In-hospital mortality rate did not decrease from 1995–1997 to 2003–2005 (5.1 to 5.9%); in-hospital mortality rate increased for surgeons undertaking <1 pancreaticoduodenectomy every 2 months (5.5 to 12.3%, p < 0.01). For 2003–2005, frequency with which pancreaticoduodenectomy is conducted inversely correlates with ALOS (p = 0.001), hospital charges (p = 0.001), and in-hospital mortality (p = 0.001).


In Florida, more pancreaticoduodenectomies are carried out by fewer surgeons. Mortality has not decreased because of surgeons infrequently performing pancreaticoduodenectomy. Most pancreaticoduodenectomies are still undertaken by surgeons who conduct pancreaticoduodenectomy infrequently with greater lengths of stay, hospital costs, and in-hospital mortality rates. To an even greater extent than previously documented, patients are best served by surgeons frequently performing pancreaticoduodenectomy.


Pancreaticoduodenectomy Pancreatic cancer High-volume 


  1. 1.
    Gordon TA, Bowman HM, Bass EB, et al. Complex gastrointestinal surgery: impact of provider experience on clinical and economic outcomes. J Am Coll Surg 1999;189:46–56.PubMedCrossRefGoogle Scholar
  2. 2.
    Birkmeyer JD, Siewers AE, Finlayson EVA, et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128–1137.PubMedCrossRefGoogle Scholar
  3. 3.
    Dimick JB, Cowan JA Jr, Colletti LM, Upchurch GR Jr. Hospital teaching status and outcomes of complex surgical procedures in the United States. Arch Surg 2004;139:137–141.PubMedCrossRefGoogle Scholar
  4. 4.
    Urbach DR, Baxter NN. Does it matter what a hospital is “high volume” for? Specificity of hospital volume–outcome associations for surgical procedures: analysis of administrative data. Qual Saf Health Care 2004;13:379–383.PubMedCrossRefGoogle Scholar
  5. 5.
    Liberman MD, Kilburn H, Lindsey M, Brennan MF. Relation of preoperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg 1995;222:638–645.CrossRefGoogle Scholar
  6. 6.
    Gordon TA, Bowman HM, Tielsch JM, et al. Statewide regionalization of pancreaticoduodenectomy and its effect on in-hospital mortality. Ann Surg 1998;228:71–78.PubMedCrossRefGoogle Scholar
  7. 7.
    Sosa JA, Bowman HM, Gordon TA, et al. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg 1998;228:429–438.PubMedCrossRefGoogle Scholar
  8. 8.
    Birkmeyer JD, Warshaw AL, Finalayson SRG, Grove MR, Tosteson ANA. Relationship between hospital volume and late survival after pancreaticoduodenectomy. Surgery 1999;126:178–183.PubMedGoogle Scholar
  9. 9.
    Gouma DJ, van Geenen RCI, van Gulik TM, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg 2000;232:786–795.PubMedCrossRefGoogle Scholar
  10. 10.
    Ho V, Heslin MJ. Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann Surg 2003;237:409–514.CrossRefGoogle Scholar
  11. 11.
    Birkmeyer JD. Raising the bar for pancreaticoduodenectomy. Ann Surg Oncol 2002;9:826–827.PubMedCrossRefGoogle Scholar
  12. 12.
    Muscari F, Suc B, Kirzin S, et al. Risk factors for mortality and intra-abdominal complications after pancreaticoduodenectomy: multivariate analysis in 300 patients. Surgery 2005;139:591–598.CrossRefGoogle Scholar
  13. 13.
    Wray CJ, Ahmad SA, Matthews JB, Lowy AM. Surgery for pancreatic cancer: recent controversies and current practice. Gastroenterol 2005;128:1626–1641.CrossRefGoogle Scholar
  14. 14.
    Di Giorgio A, Alfieri S, Rotondi F, et al. Pancreaticoduodenectomy for tumors of vater’s ampulla: report on 94 consecutive patients. World J Surg 2005;29:513–518.PubMedCrossRefGoogle Scholar
  15. 15.
    Metreveli RE, Sahm K, Abdel-Misih R, Petrelli NJ. Major pancreatic resections for suspected cancer in a community-based teaching hospital: lessons learned. J Surg Oncol 1997;95:201–206.CrossRefGoogle Scholar
  16. 16.
    Rosemurgy AS, Bloomston M, Serafini FM, et al. Frequency with which surgeons undertake pancreaticoduodenectomy determines length of stay, hospital charges, and in-hospital mortality. J Gastrointest Surg 2001;5:21–26.PubMedCrossRefGoogle Scholar
  17. 17.
    Birkmeyer JD, Stukel TA, Siewers AE, et al. Surgeon volume and operative mortality in the United States. N Engl J Med 2003;349:2117–2127.PubMedCrossRefGoogle Scholar
  18. 18.
    Ho V, Heslin MJ, Yun H, Howard L. Trends in hospital and surgeon volume and operative mortality for cancer surgery. Ann Surg Oncol 2006;13:851–858.PubMedCrossRefGoogle Scholar
  19. 19.
    Hoshal VL Jr, Benedict MB, David LR, Kulick J. Personal experience with the Whipple operation: outcomes and lessons learned. Am Surg 2004;70:121–126.PubMedGoogle Scholar
  20. 20.
    Bottger TC, Junginger T. Factors influencing morbidity and mortality after pancreaticoduodenectomy: critical analysis of 221 resections. World J Surg 1999;23:164–172.PubMedCrossRefGoogle Scholar
  21. 21.
    Schmidt CM, Powell ES, Yiannoutsos CT, et al. Pancreaticoduodenectomy: a 20-year experience in 516 patients. Arch Surg 2004;139:718–727.PubMedCrossRefGoogle Scholar
  22. 22.
    Dasgupta R, Kim PCW. Relationship between surgical volume and clinical outcome: should pediatric surgeons be doing pancreaticoduodenectomies? J Ped Surg 2005;40:793–796.CrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2007

Authors and Affiliations

  • Alexander Rosemurgy
    • 1
    • 2
    Email author
  • Sarah Cowgill
    • 1
    • 2
  • Brian Coe
    • 1
    • 2
  • Ashley Thomas
    • 1
    • 2
  • Sam Al-Saadi
    • 1
    • 2
  • Steven Goldin
    • 1
    • 2
  • Emmanuel Zervos
    • 1
    • 2
  1. 1.Digestive Disorders CenterTampa General Hospital, University of South FloridaTampaUSA
  2. 2.Division of General SurgeryUniversity of South Florida, Tampa General HospitalTampaUSA

Personalised recommendations