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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

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.

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Authors and Affiliations

  1. Hepatobiliary and Pancreatic Surgery Program, Providence Portland Medical Center, Portland, OR, USA

    Timothy J. Kennedy, Maria A. Cassera, Ronald Wolf & Paul D. Hansen

  2. Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, OR, USA

    Maria A. Cassera, Lee L. Swanstrom & Paul D. Hansen

  3. Westside Surgical Division, The Oregon Clinic, Portland, OR, USA

    Ronald Wolf

  4. Department of Surgery, Providence Medical Center, 4805 NE Glisan St., Suite 6N50, Portland, OR, 97213, USA

    Paul D. Hansen

Authors
  1. Timothy J. Kennedy
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  2. Maria A. Cassera
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  3. Ronald Wolf
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  4. Lee L. Swanstrom
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  5. Paul D. Hansen
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Corresponding author

Correspondence to Paul D. Hansen.

Additional information

This project was accepted as an oral poster presentation at the American Hepato-Pancreato-Biliary Association (AHPBA) 2009 annual meeting in Miami Beach, FL, USA, March 12–15, 2009.

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Kennedy, T.J., Cassera, M.A., Wolf, R. et al. Surgeon Volume Versus Morbidity and Cost in Patients Undergoing Pancreaticoduodenectomy in an Academic Community Medical Center. J Gastrointest Surg 14, 1990–1996 (2010). https://doi.org/10.1007/s11605-010-1280-1

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  • DOI: https://doi.org/10.1007/s11605-010-1280-1

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