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Presence of a fellowship improves perioperative outcomes following hepatopancreatobiliary procedures

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Abstract

Introduction

There is an increase in subspecialization and in the number of surgeons seeking fellowship training in the USA. Little is known regarding the effect of hepatopancreatobiliary (HPB) fellowship programs’ status of an institution on perioperative outcomes. This study aims to examine the effect of such status on perioperative outcomes across all institutions following complex surgeries involving HPB procedures in the State of New York (NYS).

Methods

The Statewide Planning and Research Cooperative System administrative database was used to identify several complex surgeries involving the pancreas, liver, and gallbladder by using ICD-9 codes for inpatient procedures between 2012 and 2014. Procedures were compared in terms of 30-day readmission, hospital length of stay (HLOS), and major complications between institutions with and without fellowship. Linear mixed model and generalized linear mixed models were used to compare the differences.

Results

There were 4156 procedures identified during 2012–2014 in NYS. Among these, 1685 (40.5%) were pancreatic surgeries only, 1031 (24.8%) were liver surgeries only, 1288 (31.0%) were gallbladder surgeries only, 11 (0.3%) were both pancreatic and liver surgeries, 124 (3.0%) were both liver and gallbladder, and 17 (0.4%) were both pancreatic and gallbladder. Elderly patients tended to go to the hospitals with HPB fellowship. Following multivariable regression and controlling for other factors, hospitals with fellowships remained significantly associated with less severe complications (OR 0.49, 95% CI 0.29–0.83, p = 0.0075). No significant differences were seen between hospitals with and without fellowship in terms of 30-day readmissions (p = 0.6) and HLOS (p = 0.4).

Conclusion

Institutions offering HPB fellowship training were associated with significantly improved rate of complications, although there was no significant difference in terms of 30-day readmission rate or HLOS. This data highlight the importance of a presence of a fellowship in complex hepatopancreatobiliary procedures.

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Acknowledgements

We would like to thank the statistical support from the Biostatistical Consulting Core, School of Medicine, Stony Brook University.

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Authors and Affiliations

  1. Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, NY, 11794, USA

    Maria S. Altieri, Catherine Frenkel, Mark Talamini, Dana A. Telem & Aurora Pryor

  2. Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA

    Jie Yang

  3. Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA

    Donglei Yin

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  1. Maria S. Altieri
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  2. Jie Yang
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  3. Donglei Yin
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  4. Catherine Frenkel
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  5. Mark Talamini
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  6. Dana A. Telem
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  7. Aurora Pryor
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Correspondence to Maria S. Altieri.

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Disclosures

Drs. Maria S Altieri, Jie Yang, CatherineFrenkel, Mark Talamini and Ms. Donglei Yin have no conflicts of interest. Dr. Aurora Pryor serves as a consultant for Apollo, Intuitive and Freehold Medical, in an investigator with Baronova and Obalon, and serves as a speaker for Ethicon and Gore. Dr. Dana Telem serves as a consultant for Medtronic, Gore and Ethicon and receives research support from Cook and Surgiquest.

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Altieri, M.S., Yang, J., Yin, D. et al. Presence of a fellowship improves perioperative outcomes following hepatopancreatobiliary procedures. Surg Endosc 31, 2918–2924 (2017). https://doi.org/10.1007/s00464-016-5306-y

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  • DOI: https://doi.org/10.1007/s00464-016-5306-y

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