Published online Aug 27, 2016. doi: 10.4240/wjgs.v8.i8.583
Peer-review started: March 7, 2016
First decision: April 11, 2016
Revised: April 20, 2016
Accepted: May 17, 2016
Article in press: May 27, 2016
Published online: August 27, 2016
To analyse the impact of turning of our department from a low to a high volume provider of pancreaticoduodenectomy (PD) on surgical outcome.
A retrospective collection of data was done for patients who underwent PD. According to the number of PDs undertaken per year, we categorized the volume into low volume (< 10 PDs/year), medium volume (10-24 PDs/year) and high volume (> 25 PDs/year) groups.
From 2002 to 2013, 200 patients underwent PD. The annual number of PD increased from 4 in 2002 to 34 in 2013. The mean operative time, operative blood loss and need for intraoperative blood transfusion decreased considerably over the volume categories (P < 0.001, P < 0.001 and P < 0.001, respectively). Increased procedural volume was associated with a lower morbidity (P = 0.021) and shorter length of hospital stay (P < 0.001). Similarly the rate of mortality dropped from 10% for the low volume group to 2.2% for the medium volume group and 0.0% for the high volume group (P = 0.007).
The transformation from a low volume to a high volume provider of PD resulted in most favourable outcomes favouring the continued centralization of this high risk procedure.
Core tip: Due to the complexity and challenging nature of pancreaticoduodenectomy, it is likely that both short- and long-term outcomes strongly depend on the cumulative number of cases performed by the surgeon as well as by the hospital. Strong evidence exists for volume-outcome relationship in which high volume centres have reduced perioperative morbidity and mortality. High volume hospitals are assumed to have structural characteristics associated with better quality of care, and providers in these hospitals are thought to improve their processes of care through experience in providing complex care. While the findings of this study are presented in terms of high, medium, and low volume periods, an important point exists regarding the volume-outcome relationship that must be emphasized. Thus for patients seeking to identify a hospital at which to have their surgery, the best strategy if all other factors are equal is to choose the hospital that performs pancreatic surgery most frequently.