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Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality.
- Source :
- British Journal of Surgery; Mar2012, Vol. 99 Issue 3, p404-410, 7p
- Publication Year :
- 2012
-
Abstract
- Background: The impact of nationwide centralization of pancreaticoduodenectomy (PD) on mortality is largely unknown. The aim of this study was to analyse changes in hospital volumes and in-hospital mortality after PD in the Netherlands between 2004 and 2009. Methods: Nationwide data on International Classification of Diseases, ninth revision (ICD-9) code 5-526 (PD, including Whipple), patient age, sex and mortality were retrieved from the independent nationwide KiwaPrismant registry. Based on established cut-off points of annually performed PDs, hospitals were categorized as very low (fewer than 5), low (5-10), medium (11-19) or high (at least 20) volume. A subgroup analysis based on a cut-off age of 70 years was also performed. Results: Some 2155 PDs were included. The number of hospitals performing PD decreased from 48 in 2004 to 30 in 2009 ( P = 0·011). In these specific years, the proportion of patients undergoing PD in a medium- or high-volume centre increased from 52·9 to 91·2 per cent ( P < 0·001). Nationwide mortality rates after PD decreased from 9·8 to 5·1 per cent ( P = 0·044). The mortality rate during the 6-year period was 14·7, 9·8, 6·3 and 3·3 per cent in very low-, low-, medium- and high-volume hospitals respectively ( P < 0·001). The difference in mortality between medium- and high-volume centres was statistically significant ( P = 0·004). The volume-outcome relationship was not influenced by age ( P = 0·467). The mortality rate after PD in patients aged at least 70 years was 10·4 per cent compared with 4·4 per cent in younger patients ( P < 0·001). Conclusion: With nationwide centralization of PD, the in-hospital mortality rate after this procedure decreased. Further centralization of PD is likely to decrease mortality further, especially in the elderly. Copyright © 2012 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [ABSTRACT FROM AUTHOR]
- Subjects :
- PANCREATICODUODENECTOMY
PANCREATECTOMY
HOSPITALS
MORTALITY
Subjects
Details
- Language :
- English
- ISSN :
- 00071323
- Volume :
- 99
- Issue :
- 3
- Database :
- Complementary Index
- Journal :
- British Journal of Surgery
- Publication Type :
- Academic Journal
- Accession number :
- 70714272
- Full Text :
- https://doi.org/10.1002/bjs.8664