Journal of Gastrointestinal Surgery

, Volume 14, Issue 12, pp 1990–1996 | Cite as

Surgeon Volume Versus Morbidity and Cost in Patients Undergoing Pancreaticoduodenectomy in an Academic Community Medical Center

  • Timothy J. Kennedy
  • Maria A. Cassera
  • Ronald Wolf
  • Lee L. Swanstrom
  • Paul D. Hansen
Original Article

Abstract

Background

Despite trends toward regionalization of care, the majority of pancreaticoduodenectomies (PD) are performed in community hospitals by surgeons with varying degrees of experience. We analyzed the impact of several variables, including surgeon volume, on outcomes following PD within a high-volume community-based teaching hospital system.

Methods

Patients who underwent PD from 2005 to 2008 were reviewed retrospectively. Perioperative data, complications, and hospital financial data was queried. A high-volume (HV) surgeon was defined as an average of 10 or more PD per year.

Results

Ninety-four patients underwent PD with an overall operative mortality rate of 9.6% (HV 2.2%, LV 16.0%), major complication rate of 32% (HV 18%, LV 44%), and median cost of $30,860 (HV $27,185, LV $33,007). Factors predictive of death were age (p < 0.02), body mass index (p < 0.01), and surgeon volume (p < 0.05). Factors predictive of major complication were surgeon volume (p < 0.01) and body mass index (p < 0.01). Factors predictive for increased length of stay for patients discharged from the hospital were surgeon volume (p < 0.02) and preoperative ASA classification (p < 0.05).

Conclusions

Surgeon volume and patient body mass index have a significant impact on perioperative morbidity following PD in a community teaching hospital.

Keywords

Pancreaticoduodenectomy Cost analysis Surgical morbidity Surgeon volume 

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Copyright information

© The Society for Surgery of the Alimentary Tract 2010

Authors and Affiliations

  • Timothy J. Kennedy
    • 1
  • Maria A. Cassera
    • 1
    • 2
  • Ronald Wolf
    • 1
    • 3
  • Lee L. Swanstrom
    • 2
  • Paul D. Hansen
    • 1
    • 2
    • 4
  1. 1.Hepatobiliary and Pancreatic Surgery ProgramProvidence Portland Medical CenterPortlandUSA
  2. 2.Gastrointestinal and Minimally Invasive Surgery DivisionThe Oregon ClinicPortlandUSA
  3. 3.Westside Surgical DivisionThe Oregon ClinicPortlandUSA
  4. 4.Department of SurgeryProvidence Medical CenterPortlandUSA

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