Quality Comes with the (Anatomic) Territory: Evaluating the Impact of Surgeon Operative Mix on Patient Outcomes After Pancreaticoduodenectomy
| Autor: | Gerard M. Doherty, Ryan Morgan, Amy K. Rosen, Sowmya R. Rao, David McAneny, Krista J. Hachey, Jennifer F. Tseng, Teviah E. Sachs |
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| Rok vydání: | 2018 |
| Předmět: |
Male
medicine.medical_specialty Databases Factual medicine.medical_treatment Odds Pancreaticoduodenectomy 03 medical and health sciences 0302 clinical medicine Postoperative Complications medicine Humans Hospital Mortality Digestive System Surgical Procedures Aged Surgeons Inpatient mortality business.industry Gastric operations Postoperative complication Odds ratio Length of Stay Middle Aged Confidence interval United States Surgery Treatment Outcome Oncology 030220 oncology & carcinogenesis 030211 gastroenterology & hepatology Female Clinical Competence business Lower mortality |
| Zdroj: | Annals of surgical oncology. 25(13) |
| ISSN: | 1534-4681 |
| Popis: | Recent support for centralization of complex operations, such as pancreaticoduodenectomy (PD), is based on surgeon-specific volume–outcome relationships. This study examined whether volume of anatomically related operations (operative mix), besides PD, is also independently associated with postoperative outcomes after PD. The study queried the Nationwide Inpatient Sample (2004–2009) for surgeons performing PD. Operative mix (OM) was defined as the year-specific number of other pancreatic, hepatic, biliary, and gastric operations performed by individual surgeons. Regression models included surgeon and hospital PD volume, adjusted for other hospital- and patient-specific factors. Among 1747 surgeons, 88.3% had low PD volume (≤ 5 cases/year), 8.9% had moderate PD volume (6–16 cases/year), and 2.8% had high PD volume (≥ 17 cases/year). Low-PD-volume surgeons with high OM (≥ 21 cases/year) (4.4%), moderate-PD-volume surgeons with high OM (3.4%), and high-PD-volume surgeons with high OM (2.7%) each had lower mortality than low-PD-volume surgeons with low OM (9.3%; all p ≤ 0.02). The frequency of prolonged hospitalization among low-PD/high-OM surgeons (45.3%) was lower than among low-PD/low-OM surgeons (61.6%; p |
| Databáze: | OpenAIRE |
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