Advertisement

Journal of Gastrointestinal Surgery

, Volume 19, Issue 9, pp 1581–1592 | Cite as

Trends in Hospital Volume and Failure to Rescue for Pancreatic Surgery

  • Neda Amini
  • Gaya Spolverato
  • Yuhree Kim
  • Timothy M. PawlikEmail author
2015 SSAT Quick Shot Presentation

Abstract

Background

We sought to evaluate trends in selection of high volume (HV) hospitals for pancreatic surgery, as well as examine trends in preoperative complications, mortality, and failure to rescue (FTR).

Method

Patients who underwent pancreatic resection between 2000 and 2011 were identified from the Nationwide Inpatient Sample (NIS). Preoperative morbidity, mortality, and FTR were examined over time. Hospital volume was stratified into tertiles based on the number of pancreatic resections per year for each time period. Logistic regression models were used to assess the effect of hospital volume on risk of complication, postoperative mortality, and FTR over time.

Result

A total of 35,986 patients were identified. Median hospital volume increased from 13 in 2000–2003 to 55 procedures/year in 2008–2011 (P < 0.001). Morbidity remained relatively the same over time at low volume (LV), intermediate volume (IV), and HV hospitals (all P > 0.05). Overall postoperative mortality was 5 %, and it decreased over time across all hospital volumes (P < 0.05). FTR was more common at LV (12.0 %) and IV (8.5 %) volume hospitals compared with HV hospitals (6.4 %). The improvement in FTR over time was most pronounced at LV and IV hospitals versus HV hospitals (P = 0.001).

Conclusion

Median hospital volume for pancreatic surgery has increased over the past decade. While the morbidity remained relatively stable over time, mortality improved especially in LV and IV hospitals. This improvement in mortality seems to be related to a decreased FTR.

Keywords

Hospital volume Pancreas Failure to rescue Surgery 

References

  1. 1.
    Winter JM, Brennan MF, Tang LH, D’Angelica MI, Dematteo RP, Fong Y, Klimstra DS, Jarnagin WR, Allen PJ. Survival after resection of pancreatic adenocarcinoma: results from a single institution over three decades. Ann Surg Oncol 2012;19:169-75.CrossRefPubMedGoogle Scholar
  2. 2.
    Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, Sauter PK, Coleman J, Hruban RH, Lillemoe KD. Resected adenocarcinoma of the pancreas-616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 2000;4:567-79.CrossRefPubMedGoogle Scholar
  3. 3.
    Gasper WJ, Glidden DV, Jin C, Way LW, Patti MG. Has recognition of the relationship between mortality rates and hospital volume for major cancer surgery in California made a difference?: A follow-up analysis of another decade. Ann Surg 2009;250:472-83.PubMedGoogle Scholar
  4. 4.
    Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med 2011;364:2128-37.PubMedCentralCrossRefPubMedGoogle Scholar
  5. 5.
    McNulty NJ, Francis IR, Platt JF, Cohan RH, Korobkin M, Gebremariam A. Multi--detector row helical CT of the pancreas: effect of contrast-enhanced multiphasic imaging on enhancement of the pancreas, peripancreatic vasculature, and pancreatic adenocarcinoma. Radiology 2001;220:97-102.Google Scholar
  6. 6.
    House MG, Yeo CJ, Cameron JL, Campbell KA, Schulick RD, Leach SD, Hruban RH, Horton KM, Fishman EK, Lillemoe KD. Predicting resectability of periampullary cancer with three-dimensional computed tomography. J Gastrointest Surg 2004;8:280-8.CrossRefPubMedGoogle Scholar
  7. 7.
    Teh SH, Diggs BS, Deveney CW, Sheppard BC. Patient and hospital characteristics on the variance of perioperative outcomes for pancreatic resection in the United States: a plea for outcome-based and not volume-based referral guidelines. Arch Surg 2009;144:713-21.CrossRefPubMedGoogle Scholar
  8. 8.
    Cameron JL, Riall TS, Coleman J, Belcher KA. One thousand consecutive pancreaticoduodenectomies. Ann Surg 2006;244:10-5.PubMedCentralCrossRefPubMedGoogle Scholar
  9. 9.
    McPhee JT, Hill JS, Whalen GF, Zayaruzny M, Litwin DE, Sullivan ME, Anderson FA, Tseng JF. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg 2007;246:246.PubMedCentralCrossRefPubMedGoogle Scholar
  10. 10.
    Hill JS, McPhee JT, Whalen GF, Sullivan ME, Warshaw AL, Tseng JF. In-hospital mortality after pancreatic resection for chronic pancreatitis: population-based estimates from the nationwide inpatient sample. J Am Coll Surg 2009;209:468-76.CrossRefPubMedGoogle Scholar
  11. 11.
    Bassi C, Falconi M, Salvia R, Mascetta G, Molinari E, Pederzoli P. Management of Complications after Pancreaticoduodenectomy in a High Volume Centre: Results on 150 Consecutive Patients / with Invited Commentary. Digestive Surgery 2001;18:453-8.CrossRefPubMedGoogle Scholar
  12. 12.
    DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, Clavien P-A. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg 2006;244:931.PubMedCentralCrossRefPubMedGoogle Scholar
  13. 13.
    Yeo CJ, Cameron JL, Sohn TA, Lillemoe KD, Pitt HA, Talamini MA, Hruban RH, Ord SE, Sauter PK, Coleman J. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann Surg 1997;226:248.PubMedCentralCrossRefPubMedGoogle Scholar
  14. 14.
    Greenblatt DY, Kelly KJ, Rajamanickam V, Wan Y, Hanson T, Rettammel R, Winslow ER, Cho CS, Weber SM. Preoperative factors predict perioperative morbidity and mortality after pancreaticoduodenectomy. Annals of surgical oncology 2011;18:2126-35.CrossRefPubMedGoogle Scholar
  15. 15.
    Spolverato G, Ejaz A, Hyder O, Kim Y, Pawlik TM. Failure to rescue as a source of variation in hospital mortality after hepatic surgery. Br J Surg 2014;101:836-46.CrossRefPubMedGoogle Scholar
  16. 16.
    Schneider EB, Ejaz A, Spolverato G, Hirose K, Makary MA, Wolfgang CL, Ahuja N, Weiss M, Pawlik TM. Hospital volume and patient outcomes in hepato-pancreatico-biliary surgery: is assessing differences in mortality enough? J Gastrointest Surg 2014;18:2105-15.CrossRefPubMedGoogle Scholar
  17. 17.
    Wouters MW, Wijnhoven BP, Karim-Kos HE, Blaauwgeers HG, Stassen LP, Steup WH, Tilanus HW, Tollenaar RA. High-volume versus low-volume for esophageal resections for cancer: the essential role of case-mix adjustments based on clinical data. Ann Surg Oncol 2008;15:80-7.PubMedCentralCrossRefPubMedGoogle Scholar
  18. 18.
    Glasgow RE, Mulvihill SJ. Hospital volume influences outcome in patients undergoing pancreatic resection for cancer. Western journal of medicine 1996;165:294.PubMedCentralPubMedGoogle Scholar
  19. 19.
    Goodney PP, Stukel TA, Lucas FL, Finlayson EV, Birkmeyer JD. Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann Surg 2003;238:161-7.PubMedCentralPubMedGoogle Scholar
  20. 20.
    Nordback L, Parviainen M, Raty S, Kuivanen H, Sand J. Resection of the head of the pancreas in Finland: effects of hospital and surgeon on short-term and long-term results. Scand J Gastroenterol 2002;37:1454-60.CrossRefPubMedGoogle Scholar
  21. 21.
    Fong Y, Gonen M, Rubin D, Radzyner M, Brennan MF. Long-term survival is superior after resection for cancer in high-volume centers. Ann Surg 2005;242:540-4; discussion 4-7.PubMedCentralPubMedGoogle Scholar
  22. 22.
    Riall TS, Eschbach KA, Townsend CM, Jr., Nealon WH, Freeman JL, Goodwin JS. Trends and disparities in regionalization of pancreatic resection. J Gastrointest Surg 2007;11:1242-51; discussion 51-2.CrossRefPubMedGoogle Scholar
  23. 23.
    Gordon TA, Bowman HM, Tielsch JM, Bass EB, Burleyson GP, Cameron JL. Statewide regionalization of pancreaticoduodenectomy and its effect on in-hospital mortality. Ann Surg 1998;228:71-8.PubMedCentralCrossRefPubMedGoogle Scholar
  24. 24.
    Dimick JB, Pronovost PJ, Cowan JA, Jr., Lipsett PA, Stanley JC, Upchurch GR, Jr. Variation in postoperative complication rates after high-risk surgery in the United States. Surgery 2003;134:534-40; discussion 40-1.CrossRefPubMedGoogle Scholar
  25. 25.
    Jones RM, Moulton CE, Hardy KJ. Central venous pressure and its effect on blood loss during liver resection. Br J Surg 1998;85:1058-60.CrossRefPubMedGoogle Scholar
  26. 26.
    Cammu G, Troisi R, Cuomo O, de Hemptinne B, Di Florio E, Mortier E. Anaesthetic management and outcome in right-lobe living liver-donor surgery. Eur J Anaesthesiol 2002;19:93-8.CrossRefPubMedGoogle Scholar
  27. 27.
    Birkmeyer JD, Dimick JB, Staiger DO. Operative mortality and procedure volume as predictors of subsequent hospital performance. Ann Surg 2006;243:411-7.PubMedCentralCrossRefPubMedGoogle Scholar
  28. 28.
    Hollenbeck BK, Dunn RL, Miller DC, Daignault S, Taub DA, Wei JT. Volume-based referral for cancer surgery: informing the debate. J Clin Oncol 2007;25:91-6.CrossRefPubMedGoogle Scholar
  29. 29.
    Ghaferi AA, Birkmeyer JD, Dimick JB. Variation in hospital mortality associated with inpatient surgery. N Engl J Med 2009;361:1368-75.CrossRefPubMedGoogle Scholar
  30. 30.
    Birkmeyer NJ, Goodney PP, Stukel TA, Hillner BE, Birkmeyer JD. Do cancer centers designated by the National Cancer Institute have better surgical outcomes? Cancer 2005;103:435-41.CrossRefPubMedGoogle Scholar
  31. 31.
    Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE. Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128-37.CrossRefPubMedGoogle Scholar
  32. 32.
    Pal N, Axisa B, Yusof S, Newcombe RG, Wemyss-Holden S, Rhodes M, Lewis MP. Volume and outcome for major upper GI surgery in England. J Gastrointest Surg 2008;12:353-7.CrossRefPubMedGoogle Scholar
  33. 33.
    Finlayson SR, Birkmeyer JD, Tosteson AN, Nease RF, Jr. Patient preferences for location of care: implications for regionalization. Med Care 1999;37:204-9.CrossRefPubMedGoogle Scholar
  34. 34.
    Chappel AR, Zuckerman RS, Finlayson SR. Small rural hospitals and high-risk operations: how would regionalization affect surgical volume and hospital revenue? J Am Coll Surg 2006;203:599-604.CrossRefPubMedGoogle Scholar
  35. 35.
    Ward MM, Jaana M, Wakefield DS, Ohsfeldt RL, Schneider JE, Miller T, Lei Y. What would be the effect of referral to high-volume hospitals in a largely rural state? J Rural Health 2004;20:344-54.CrossRefPubMedGoogle Scholar
  36. 36.
    Dimick JB, Finlayson SR, Birkmeyer JD. Regional availability of high-volume hospitals for major surgery. Health Aff (Millwood) 2004;Suppl Variation:VAR45-53.Google Scholar
  37. 37.
    HCUP National Inpatient Sample (NIS). Healthcare Cost and Utilization Project (HCUP). 2011 AfHRaQ, Rockville, MD. www.hcup-us.ahrq.gov/nisoverview.jsp.
  38. 38.
    Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. Journal of chronic diseases 1987;40:373-83.CrossRefPubMedGoogle Scholar
  39. 39.
    Quan H, Parsons GA, Ghali WA. Validity of information on comorbidity derived rom ICD-9-CCM administrative data. Med Care 2002;40:675-85.CrossRefPubMedGoogle Scholar
  40. 40.
    Ejaz A, Sachs T, He J, Spolverato G, Hirose K, Ahuja N, Wolfgang CL, Makary MA, Weiss M, Pawlik TM. A comparison of open and minimally invasive surgery for hepatic and pancreatic resections using the Nationwide Inpatient Sample. Surgery 2014;156:538-47.PubMedCentralCrossRefPubMedGoogle Scholar
  41. 41.
    Ghaferi AA, Birkmeyer JD, Dimick JB. Complications, failure to rescue, and mortality with major inpatient surgery in medicare patients. Ann Surg 2009;250:1029-34.CrossRefPubMedGoogle Scholar
  42. 42.
    Birkmeyer JD, Sun Y, Wong SL, Stukel TA. Hospital volume and late survival after cancer surgery. Ann Surg 2007;245:777-83.PubMedCentralCrossRefPubMedGoogle Scholar
  43. 43.
    Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 2000;283:1159-66.CrossRefPubMedGoogle Scholar
  44. 44.
    Hill JS, McPhee JT, Messina LM, Ciocca RG, Eslami MH. Regionalization of abdominal aortic aneurysm repair: evidence of a shift to high-volume centers in the endovascular era. J Vasc Surg 2008;48:29-36.CrossRefPubMedGoogle Scholar
  45. 45.
    Yokoe M. Does higher hospital volume improve the patient outcome in acute pancreatitis? J Gastroenterol 2014;49:371-2.CrossRefPubMedGoogle Scholar
  46. 46.
    Sosa JA, Bowman HM, Gordon TA, Bass EB, Yeo CJ, Lillemoe KD, Pitt HA, Tielsch JM, Cameron JL. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg 1998;228:429-38.PubMedCentralCrossRefPubMedGoogle Scholar
  47. 47.
    Birkmeyer JD, Warshaw AL, Finlayson SR, Grove MR, Tosteson AN. Relationship between hospital volume and late survival after pancreaticoduodenectomy. Surgery 1999;126:178-83.CrossRefPubMedGoogle Scholar
  48. 48.
    McPhee JT, Hill JS, Whalen GF, Zayaruzny M, Litwin DE, Sullivan ME, Anderson FA, Tseng JF. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg 2007;246:246-53.PubMedCentralCrossRefPubMedGoogle Scholar
  49. 49.
    Birkmeyer JD, Finlayson EV, Birkmeyer CM. Volume standards for high-risk surgical procedures: potential benefits of the Leapfrog initiative. Surgery 2001;130:415-22.CrossRefPubMedGoogle Scholar
  50. 50.
    Nallamothu BK, Saint S, Ramsey SD, Hofer TP, Vijan S, Eagle KA. The role of hospital volume in coronary artery bypass grafting: is more always better?1. Journal of the American College of Cardiology 2001;38:1923-30.CrossRefPubMedGoogle Scholar
  51. 51.
    Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL. Surgeon Volume and Operative Mortality in the United States. New England Journal of Medicine 2003;349:2117-27.CrossRefPubMedGoogle Scholar
  52. 52.
    Gonzales NR, Demaerschalk BM, Voeks JH, Tom M, Howard G, Sheffet AJ, Garcia L, Clair DG, Barr J, Orlow S, Brott TG. Complication rates and center enrollment volume in the carotid revascularization endarterectomy versus stenting trial. Stroke 2014;45:3320-4.CrossRefPubMedGoogle Scholar
  53. 53.
    Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann Intern Med 2002;137:511-20.CrossRefPubMedGoogle Scholar
  54. 54.
    Silber JH, Rosenbaum PR, Schwartz JS, Ross RN, Williams SV. Evaluation of the complication rate as a measure of quality of care in coronary artery bypass graft surgery. JAMA 1995;274:317-23.CrossRefPubMedGoogle Scholar
  55. 55.
    Romano PS, Mark DH. Bias in the coding of hospital discharge data and its implications for quality assessment. Med Care 1994;32:81-90.CrossRefPubMedGoogle Scholar

Copyright information

© The Society for Surgery of the Alimentary Tract 2015

Authors and Affiliations

  • Neda Amini
    • 1
  • Gaya Spolverato
    • 1
  • Yuhree Kim
    • 1
  • Timothy M. Pawlik
    • 1
    Email author
  1. 1.Department of SurgeryThe Johns Hopkins University School of MedicineBaltimoreUSA

Personalised recommendations