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A partnership model between high- and low-volume hospitals to improve results in hepatobiliary pancreatic surgery.

Authors :
Ravaioli M
Pinna AD
Francioni G
Montorsi M
Veneroni L
Grazi GL
Palini GM
Gavazzi F
Stacchini G
Ridolfi C
Serenari M
Zerbi A
Source :
Annals of surgery [Ann Surg] 2014 Nov; Vol. 260 (5), pp. 871-5; discussion 875-7.
Publication Year :
2014

Abstract

Objective: To optimize the results of low-volume (LV) centers for hepatopancreaticobiliary (HPB) surgery.<br />Background: High-volume (HV) centers for HPB surgery have lower mortality than LV. Strategies for collaboration between HV and LV centers are not well investigated.<br />Methods: Postoperative outcomes of patients undergoing curative HPB resection were evaluated at an LV hospital before (2006-2008) and during the collaboration (2009-2012) and at 2 hospitals with HV for either liver or pancreatic resection (2009-2012). Itinerant tutor surgeons from the HV centers were involved in the pre-, intra- and postoperative course of HPB patients at the LV hospital.<br />Results: HPB cases at the LV center increased from 18 to 40 patients per year from 2006 to 2012, whereas 6-month postoperative mortality decreased from 17.8% (2006-2008) to 6% (2009-2012), P<0.05 (liver: 10.3% vs 4.7% and pancreas: 29.4% vs 7.9%). During the collaborative study period, outcomes for hepatectomy were similar for LV and HV (85 vs 507 cases): postoperative Clavien-Dindo scores 4 and 5 were 2% and 0.2% for HV versus 2.4% and 1.2% for LV, respectively. Outcomes for pancreatic procedures (LV 63 vs HV 269 cases) showed better postoperative Clavien-Dindo scores 4 and 5 in the HV (0.7% score 4 and 1.5% score 5 for HV vs 3.2% and 6.3%, respectively, for LV) but the difference disappeared in the last 2 years (2011-2012) and matching the cases.<br />Conclusions: Our partnership model helped improve postoperative outcomes at the LV center. Results at the LV hospital were comparable with the HV centers, although 2 years of partnership were required to achieve this in pancreatic surgery.

Details

Language :
English
ISSN :
1528-1140
Volume :
260
Issue :
5
Database :
MEDLINE
Journal :
Annals of surgery
Publication Type :
Academic Journal
Accession number :
25243551
Full Text :
https://doi.org/10.1097/SLA.0000000000000975