Trends and Disparities in Regionalization of Pancreatic Resection
The current recommendation is that pancreatic resections be performed at hospitals doing >10 pancreatic resections annually.
To evaluate the extent of regionalization of pancreatic resection and the factors predicting resection at high-volume centers (>10 cases/year) in Texas.
Using the Texas Hospital Inpatient Discharge Public Use Data File, we evaluated trends in the percentage of patients undergoing pancreatic resection at high-volume centers (>10 cases/year) from 1999 to 2004 and determined the factors that independently predicted resection at high-volume centers.
A total of 3,189 pancreatic resections were performed in the state of Texas. The unadjusted in-hospital mortality was higher at low-volume centers (7.4%) compared to high-volume centers (3.0%). Patients resected at high-volume centers increased from 54.5% in 1999 to 63.3% in 2004 (P = 0.0004). This was the result of a decrease in resections performed at centers doing less than five resections/year (35.5% to 26.0%). In a multivariate analysis, patients who were >75 (OR = 0.51), female (OR = 0.86), Hispanic (OR = 0.58), having emergent surgery (OR = 0.39), diagnosed with periampullary cancer (OR = 0.68), and living >75 mi from a high-volume center (OR = 0.93 per 10-mi increase in distance, P < 0.05 for all OR) were less likely to be resected at high-volume centers. The odds of being resected at a high-volume center increased 6% per year.
Whereas regionalization of pancreatic resection at high-volume centers in the state of Texas has improved slightly over time, 37% of patients continue to undergo pancreatic resection at low-volume centers, with more than 25% occurring at centers doing less than five per year. There are obvious demographic disparities in the regionalization of care, but additional unmeasured barriers need to be identified.
KeywordsPancreatic resection Volume–outcome relationship Regionalization of care
- 16.U.S. Bureau of the Census. Census 2000 Summary File 1. Prepared by the U.S. Census Bureau, Washington, DC, 2001.Google Scholar
- 17.DeNavas-Walt C, Proctor BD, Lee CH. U.S. Census Bureau, Current Population Reports, P60-231. Income, Poverty, and Health Insurance Coverage in the United States: 2005, U.S. Government Printing Office, Washington, DC, 2006.Google Scholar
- 18.Texas Department of State Health Services. Medically Underserved Areas (MUAs) and Populations (MUPs) in Texas. http://www.dshs.state.tx.us/chs/hprc/mua.shtm (Accessed 3/26/2007).
- 19.Texas Department of State Health Services. Texas Health Care Information Collection Center. http://www.dshs.state.tx.us/thcic/Hospitals/HospitalData.shtm. (Accessed 3/19/2007).
- 23.Meguid RA, Ahuja N, Chang DC. What constitutes a high-volume hospital for pancreatic resection? Abstract only. Presented at the Association for Academic Surgeons, February, 2007.Google Scholar
- 26.Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J, Zahurak ML, Grochow LB, Abrams RA. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: Pathology, complications, and outcomes. Ann Surg 1997;226:248–260.PubMedCrossRefGoogle Scholar