Perry Lauren M, Canter Robert J, Gaskill Cameron E, Bold Richard J
Division of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Sacramento, United States of America.
Surg Open Sci. 2023 Nov 20;16:198-204. doi: 10.1016/j.sopen.2023.11.004. eCollection 2023 Dec.
Pancreatic cancer (PC) surgery has been associated with improved outcomes and value when performed at high-volume centers (HVC; ≥20 surgeries annually) compared to low-volume centers (LVC). Some have used these differences to suggest that regionalization of PC surgery would optimize patient outcomes and expenditures.
A Markov model was created to evaluate 30-day mortality, 30-day complications, and 30-day costs. The differences in these outcome measures between the current and future states were measured to assess the population-level benefits of regionalization. A sensitivity analysis was performed to evaluate the impact of variations of input variables in the model.
Among 5958 new cases of pancreatic cancer in California in 2021, a total of 2443 cases (41 %) would be resectable; among patients with resectable PC, a total of 977 (40 %) patients would undergo surgery. In aggregate, HVC and LVC 30-day postoperative complications occurred in 364 patients, 30-day mortality in 35 patients, and healthcare costs expended managing complications were $6,120,660. In the predictive model of complete regionalization to only HVC in California, an estimated 29 fewer complications, 17 fewer deaths, and a cost savings of $487,635 per year would occur.
Pancreatic cancer (PC) surgery has been associated with improved outcomes and value when performed at high-volume centers (HVC; ≥20 surgeries annually) compared to low-volume centers (LVC). Complete regionalization of pancreatic cancer surgery predicted benefits in mortality, complications and cost, though implementing this strategy at a population-level may require investment of resources and redesigning care delivery models.
与低容量中心（LVC，每年手术量＜20例）相比，在高容量中心（HVC，每年手术量≥20例）进行胰腺癌（PC）手术，其预后和价值有所改善。一些人利用这些差异表明，胰腺癌手术的区域化将优化患者预后并降低费用。
创建一个马尔可夫模型来评估30天死亡率、30天并发症和30天费用。测量当前状态与未来状态之间这些预后指标的差异，以评估区域化在人群层面的益处。进行敏感性分析以评估模型中输入变量变化的影响。
在2021年加利福尼亚州的5958例新发胰腺癌病例中，共有2443例（41%）可切除；在可切除的胰腺癌患者中，共有977例（40%）接受了手术。总体而言，HVC和LVC的30天术后并发症发生在364例患者中，30天死亡率为35例，处理并发症的医疗费用为6120660美元。在加利福尼亚州仅向HVC完全区域化的预测模型中，估计每年并发症减少29例，死亡减少17例，成本节约487635美元。
与低容量中心（LVC）相比，在高容量中心（HVC，每年手术量≥20例）进行胰腺癌（PC）手术，其预后和价值有所改善。胰腺癌手术的完全区域化在死亡率、并发症和成本方面有预测益处，尽管在人群层面实施该策略可能需要资源投入和重新设计护理提供模式。
