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Regionalization and Outcomes of Hepato-pancreato-biliary Cancer Surgery in USA

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Recent publications demonstrate regionalization of complex operations to high-volume centers (HVCs) in the USA. We hypothesize that this pattern applies to hepato-pancreato-biliary (HPB) cancer resections and improved outcomes.

Methods

The Nationwide Inpatient Sample (NIS) data were analyzed from 1995–1999(T1) to 2005–2009(T2) for all HPB oncologic resections. Division of hospitals into high-, mid-, and low-volume centers (HVC, MVC, LVC) was performed. Multivariate regression was utilized to identify predictors of LVC resection. Outcomes were compared in both eras.

Results

A total of 45,815 cases met the inclusion criteria (19,250 from T1 and 25,565 from T2). At T1, 32.5 % of resections were performed at HVCs and 34.9 % at LVCs. At T2, 60.8 % were performed at HVCs versus 18.5 % at LVCs. In T1, inpatient mortality at HVCs versus LVCs was 3.3 % versus 8.67 % (p < 0.0001) and 2.7 % versus 6.5 % (p < 0.0001) in T2. LOS and routine discharge were improved in HVCs, but total charges were higher. All outcomes significantly differed between HVCs and LVCs in multivariate analysis, except for LOS and total charges in T2.

Conclusion

The most recent NIS data demonstrate better outcomes in HVCs for HPB oncologic resections. These trends reflect alignment with national recommendations to centralize complex cancer surgery, as well as improved outcomes in all centers.

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Authors and Affiliations

  1. Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA

    Paul D. Colavita, Victor B. Tsirline, Igor Belyansky, Ryan Z. Swan, Amanda L. Walters, Amy E. Lincourt, David A. Iannitti & B. Todd Heniford

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  1. Paul D. Colavita
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Correspondence to B. Todd Heniford.

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Colavita, P.D., Tsirline, V.B., Belyansky, I. et al. Regionalization and Outcomes of Hepato-pancreato-biliary Cancer Surgery in USA. J Gastrointest Surg 18, 532–541 (2014). https://doi.org/10.1007/s11605-014-2454-z

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  • DOI: https://doi.org/10.1007/s11605-014-2454-z

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