Is Centralization Needed for Patients Undergoing Distal Pancreatectomy?: A Nationwide Study of 3314 Patients
| Autor: | Lilian Schwarz, Guillaume Clément, D. Theis, Edouard Roussel, F.R. Pruvot, Stéphanie Truant, Xavier Lenne, Mehdi El Amrani |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male medicine.medical_specialty Hospitals Low-Volume Databases Factual Endocrinology Diabetes and Metabolism 03 medical and health sciences 0302 clinical medicine Endocrinology Pancreatectomy Postoperative Complications Outcome Assessment Health Care Internal Medicine medicine Humans Survival rate Aged Aged 80 and over Hepatology business.industry Comorbidity score Hospital discharge database Odds ratio Surgical procedures Length of Stay Middle Aged Confidence interval Patient Discharge Surgery Pancreatic Neoplasms Survival Rate Quartile 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Female France Distal pancreatectomy business Hospitals High-Volume |
| Zdroj: | Pancreas. 48(9) |
| ISSN: | 1536-4828 |
| Popis: | Objective The centralization of complex surgical procedures is associated with better postoperative outcomes. However, little is known about the impact of hospital volume on the outcome after distal pancreatectomy. Methods Using the French national hospital discharge database, we identified all patients having undergone distal pancreatectomy in France between 2012 and 2015. A spline model was applied to determine the caseload cut-off in annual distal pancreatectomy that influenced 90-day postoperative mortality. Results A total of 3314 patients were identified. Use of a spline model did not reveal a cut-off in the annual distal pancreatectomy caseload. By taking the median number of distal pancreatectomy (n = 5) and the third quartile (n = 15), we stratified centers into low, intermediate, and high hospital volume groups. The overall postoperative mortality rate was 3.0% and did not differ significantly between these groups. In a multivariable analysis, age, Charlson comorbidity score, septic complications, hemorrhage, shock, and reoperation were independently associated with a greater overall risk of death. However, hospital volume had no impact on mortality after distal pancreatectomy (odds ratio, 0.954; 95% confidence interval, 0.552-1.651, P = 0.867). Conclusions Hospital volume does not seem to influence mortality after distal pancreatectomy in France, and centralization may not necessarily improve outcomes. |
| Databáze: | OpenAIRE |
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