Department of Surgical Oncology, City of Hope National Medical Center, 1500 E Duarte Rd., Duarte, CA, 91010, USA.
Department of Biostatistics, City of Hope National Medical Center, Duarte, CA, USA.
World J Surg. 2019 Sep;43(9):2290-2299. doi: 10.1007/s00268-019-05019-6.
Pancreatectomy for malignancy is associated with improved outcomes when performed at high-volume centers. The goal of this study was to assess pancreatectomy outcomes for premalignant cystic lesions as a function of hospital volume.
The Healthcare Cost and Utilization Project (HCUP) was queried for all pancreatectomies performed in California from 2003 to 2011. Cases were stratified, separating benign versus malignant disease. Hospitals were categorized as low-volume (≤25 pancreatectomies/year; LV) or high-volume (>25; HV) centers. Perioperative morbidity, mortality, and length of stay were compared in HV vs. LV centers.
There were 7554 pancreatectomies performed in 201 hospitals during the study period, where 5652 (75%) procedures were performed for malignancy, 338 (4%) for chronic pancreatitis, and 1564 (21%) for benign/premalignant cysts. The majority of pancreatectomies for cystic disease were performed at LV centers (65%). There were no significant differences in length of stay (7 vs. 8 days; p = 0.6) or 90-day readmission rates (12.8% vs. 12.9%; p = 1.0) in HV versus LV centers. However, there were higher surgical (46.2% LV vs. 41.1% HV, p = 0.05) and medical (13.3% LV vs. 9.2% HV; p = 0.017) complications at LV centers. Most importantly, there was a fourfold higher in-hospital mortality at LV centers (2.36% vs. 0.55%; p = 0.007).
Pancreatic resection for benign lesions at HV hospitals is associated with significantly lower morbidity and mortality, suggesting that when feasible, patients should seek care at high-volume centers for these semi-elective surgeries.
在高容量中心进行恶性肿瘤的胰腺切除术与改善预后相关。本研究的目的是评估作为医院容量函数的良性囊性病变行胰腺切除术的结果。
从 2003 年至 2011 年，对加利福尼亚州进行的所有胰腺切除术进行了医疗保健成本和利用项目（HCUP）查询。将病例分层，将良性与恶性疾病分开。将医院分为低容量（≤25 例/年；LV）或高容量（>25 例；HV）中心。在 HV 与 LV 中心比较围手术期发病率，死亡率和住院时间。
在研究期间，在 201 家医院进行了 7554 例胰腺切除术，其中 5652 例（75%）手术用于恶性肿瘤，338 例（4%）用于慢性胰腺炎，1564 例（21%）用于良性/恶性囊性病变。大多数囊性疾病的胰腺切除术是在 LV 中心进行的（65%）。HV 与 LV 中心之间在住院时间（7 天与 8 天；p = 0.6）或 90 天再入院率（12.8%与 12.9%；p = 1.0）方面无显着差异。然而，LV 中心的手术（46.2% LV 与 41.1% HV，p = 0.05）和医疗（13.3% LV 与 9.2% HV；p = 0.017）并发症更高。最重要的是，LV 中心的院内死亡率高四倍（2.36%与 0.55%；p = 0.007）。
HV 医院的良性病变胰腺切除术与显着降低的发病率和死亡率相关，这表明在可行的情况下，患者应在高容量中心寻求这些半选择性手术的治疗。
