Advertisement

Journal of Gastrointestinal Surgery

, Volume 12, Issue 9, pp 1534–1539 | Cite as

Surgical Specialization and Operative Mortality in Hepato-Pancreatico-Biliary (HPB) Surgery

  • Nicholas G. Csikesz
  • Jessica P. Simons
  • Jennifer F. Tseng
  • Shimul A. ShahEmail author
Article

Abstract

Introduction

Surgeon specialization has been shown to result in improved outcomes but may not be the sole measure of surgical quality in hepato-pancreato-biliary (HPB) surgery. We attempted to determine which factors predominate in optimal patient outcomes between volume, surgeon, and hospital resources.

Methods

All non-transplant pancreatic (n = 7195) and liver operations (n = 4809) from the Nationwide Inpatient Sample (NIS) were examined from 1998–2005. Surgeons and hospitals were divided into two groups, transplant (TX) or non-transplant (non-TX), using the unique surgeon and hospital identifier of NIS. A logistic regression model examined the relationship between factors while accounting for patient and hospital factors.

Results

We identified 4,355 primary surgeons (165 TX, 4,190 non-TX) who performed HPB surgery in 675 hospitals across 12 different states. Non-TX surgeons performed the majority of pancreatic (97%) and liver procedures (81%). There was no difference in mortality after HPB surgery depending on surgeon specialty (p = 0.59). Factors for inpatient death after HPB surgery included increasing age, male gender, and public insurance (p < 0.05). In addition, surgery performed at a TX center had a 21% lower odds of perioperative mortality.

Discussion

Non-TX surgeons performed the majority of pancreatic and liver surgery in the US. Hospital factors like support of transplantation but not surgical specialty, appeared to impact operative mortality. Future regulatory benchmarks should consider these types of center-based facilities and resources to assess patient outcomes.

Keywords

Liver Pancreas NIS Transplant Hepato-pancreatico-biliary surgery 

References

  1. 1.
    Dimick JB, Cowan JA Jr., Knol JA, Upchurch GR Jr. Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database. Arch Surg 2003;138:185–191. doi: 10.1001/archsurg.138.2.185.PubMedCrossRefGoogle Scholar
  2. 2.
    McPhee JT, Hill JS, Whalen GF et al. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg 2007;246:246–253. doi: 10.1097/01.sla.0000259993.17350.3a.PubMedCrossRefGoogle Scholar
  3. 3.
    Fong Y, Gonen M, Rubin D, Radzyner M, Brennan MF. Long-term survival is superior after resection for cancer in high-volume centers. Ann Surg 2005;242:540–544.PubMedGoogle Scholar
  4. 4.
    Axelrod DA, Guidinger MK, McCullough KP, Leichtman AB, Punch JD, Merion RM. Association of center volume with outcome after liver and kidney transplantation. Am J Transplant 2004;4:920–927. doi: 10.1111/j.1600-6143.2004.00462.x.PubMedCrossRefGoogle Scholar
  5. 5.
    Birkmeyer JD, Siewers AE, Finlayson EV et al. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128–1137. doi: 10.1056/NEJMsa012337.PubMedCrossRefGoogle Scholar
  6. 6.
    Birkmeyer JD, Sun Y, Goldfaden A, Birkmeyer NJ, Stukel TA. Volume and process of care in high-risk cancer surgery. Cancer 2006;106:2476–2481. doi: 10.1002/cncr.21888.PubMedCrossRefGoogle Scholar
  7. 7.
    Goodney PP, Stukel TA, Lucas FL, Finlayson EV, Birkmeyer JD. Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann Surg 2003;238:161–167.PubMedGoogle Scholar
  8. 8.
    Shah SA, Bromberg R, Coates A, Rempel E, Simunovic M, Gallinger S. Survival after liver resection for metastatic colorectal carcinoma in a large population. J Am Coll Surg 2007;205:676–683. doi: 10.1016/j.jamcollsurg.2007.06.283.PubMedCrossRefGoogle Scholar
  9. 9.
    Riall TS, Eschbach KA, Townsend CM Jr., Nealon WH, Freeman JL, Goodwin JS. Trends and disparities in regionalization of pancreatic resection. J Gastrointest Surg 2007;11:1242–1251. doi: 10.1007/s11605-007-0245-5 PubMedCrossRefGoogle Scholar
  10. 10.
    Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998;36:8–27. doi: 10.1097/00005650-199801000-00004.PubMedCrossRefGoogle Scholar
  11. 11.
    Shah SA, Cleary SP, Wei AC et al. Recurrence after liver resection for hepatocellular carcinoma: risk factors, treatment, and outcomes. Surgery 2007;141:330–339. doi: 10.1016/j.surg.2006.06.028.PubMedCrossRefGoogle Scholar
  12. 12.
    Fan ST, Lo CM, Liu CL et al. Hepatectomy for hepatocellular carcinoma: toward zero hospital deaths. Ann Surg 1999;229:322–330. doi: 10.1097/00000658-199903000-00004.PubMedCrossRefGoogle Scholar
  13. 13.
    El Serag HB, Siegel AB, Davila JA et al. Treatment and outcomes of treating of hepatocellular carcinoma among Medicare recipients in the United States: a population-based study. J Hepatol 2006;44:158–166. doi: 10.1016/j.jhep.2005.10.002.PubMedCrossRefGoogle Scholar
  14. 14.
    Davila JA, El Serag HB. Racial differences in survival of hepatocellular carcinoma in the United States: a population-based study. Clin Gastroenterol Hepatol 2006;4:104–110. doi: 10.1016/S1542-3565(05)00745-7.PubMedCrossRefGoogle Scholar
  15. 15.
    Riall TS, Nealon WH, Goodwin JS et al. Pancreatic cancer in the general population: improvements in survival over the last decade. J Gastrointest Surg 2006;10:1212–1223. doi: 10.1016/j.gassur.2006.08.010.PubMedCrossRefGoogle Scholar
  16. 16.
    Cummings LC, Payes JD, Cooper GS. Survival after hepatic resection in metastatic colorectal cancer: a population-based study. Cancer 2007;109:718–726. doi: 10.1002/cncr.22448.PubMedCrossRefGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2008

Authors and Affiliations

  • Nicholas G. Csikesz
    • 1
  • Jessica P. Simons
    • 1
  • Jennifer F. Tseng
    • 1
  • Shimul A. Shah
    • 1
    • 2
    Email author
  1. 1.Department of Surgery, Surgical Outcomes Analysis & ResearchUniversity of Massachusetts Medical SchoolWorcesterUSA
  2. 2.Department of SurgeryUniversity of Massachusetts Medical SchoolWorcesterUSA

Personalised recommendations