Surgical Endoscopy

, Volume 32, Issue 5, pp 2355–2364 | Cite as

Academic status does not affect outcome following complex hepato-pancreato-biliary procedures

  • Maria S. Altieri
  • Jie Yang
  • Donald Groves
  • Donglei Yin
  • Kristen Cagino
  • Mark Talamini
  • Aurora Pryor
Article

Abstract

Introduction

There is a growing debate regarding outcomes following complex hepato-pancreato-biliary (HPB) procedures. The purpose of our study is to examine if facility type has any impact on complications, readmission rates, emergency department (ED) visit rates, and length of stay (LOS) for patients undergoing HPB surgery.

Methods

The SPARCS administrative database was used to identify patients undergoing complex HPB procedures between 2012 and 2014 in New York. Univariate generalized linear mixed models were fit to estimate the marginal association between outcomes such as overall/severe complication rates, 30-day and 1-year readmission rates, 30-day and 1-year ED-visit rates, and potential risk factors. Univariate linear mixed models were used to estimate the marginal association between possible risk factors and LOS. Facility type, as well as any variables found to be significant in our univariate analysis (p = 0.05), was further included in the multivariable regression models.

Results

There were 4122 complex HPB procedures performed. Academic facilities were more likely to have a higher hospital volume (p < 0001). Surgery at academic facilities were less likely to have coexisting comorbidities; however, they were more likely to have metastatic cancer and/or liver disease (p = 0.0114, < 0. 0001, and = 0.0299, respectively). Postoperatively, patients at non-academic facilities experienced higher overall complication rates, and higher severe complication rates, when compared to those at academic facilities (p < 0.0001 and = 0.0018, respectively). Further analysis via adjustment for possible confounding factors, however, revealed no significant difference in the risk of severe complications between the two facility types. Such adjustment also demonstrated higher 30-day readmission risk in patients who underwent their surgery at an academic facility.

Conclusion

No significant difference was found when comparing the outcomes of academic and non-academic facilities, after adjusting for age, gender, race, region, insurance, and hospital volume. Patients from academic facilities were more likely to be readmitted within the first 30-days after surgery.

Keywords

Academic status Hepato-pancreato-biliary procedures 

Notes

Acknowledgements

We acknowledge the biostatistical consultation and support provided by the Biostatistical Consulting Core at School of Medicine, Stony Brook University.

Compliance with ethical standards

Disclosure

No industry or other external funding was used for this research. Dr. Pryor receives honoraria for speaking for Ethicon, Medtronic, Stryker, and Gore; is a consultant for the Medicines Company, Merck, and Intuitive. Dr. Altieri, Talamini, Yang, and Groves have nothing to disclose. Ms. Cagino and Ms. Yin have nothing to disclose.

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Copyright information

© Springer Science+Business Media, LLC 2017

Authors and Affiliations

  • Maria S. Altieri
    • 1
  • Jie Yang
    • 2
  • Donald Groves
    • 1
  • Donglei Yin
    • 3
  • Kristen Cagino
    • 1
  • Mark Talamini
    • 1
  • Aurora Pryor
    • 1
  1. 1.Division of Bariatric, Department of Surgery, Foregut and Advanced Gastrointestinal SurgeryStony Brook University Medical CenterStony BrookUSA
  2. 2.Department of Family, Population and Preventive MedicineStony Brook University Medical CenterStony BrookUSA
  3. 3.Department of Applied Mathematics and StatisticsStony Brook UniversityStony BrookUSA

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