Centralizing a national pancreatoduodenectomy service: striking the right balance
Background Centralization of pancreatic surgery is currently called for owing to superior outcomes in higher‐volume centres. Conversely, organizational and patient concerns speak for a moderation in centralization. Consensus on the optimal balance has not yet been reached. This observational study p...
Main Authors: | , , , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
Oxford University Press
2020-10-01
|
Series: | BJS Open |
Online Access: | https://doi.org/10.1002/bjs5.50342 |
id |
doaj-a10b2917288f429c9bed3475765c99f3 |
---|---|
record_format |
Article |
spelling |
doaj-a10b2917288f429c9bed3475765c99f32021-04-02T18:04:57ZengOxford University PressBJS Open2474-98422020-10-014590491310.1002/bjs5.50342Centralizing a national pancreatoduodenectomy service: striking the right balanceL. S. Nymo0D. Kleive1K. Waardal2E. A. Bringeland3J. A. Søreide4K. J. Labori5K. E. Mortensen6K. Søreide7K. Lassen8Department of Gastrointestinal Surgery University Hospital of North Tromsø NorwayDepartment of Hepatobiliary and Pancreatic Surgery Oslo University Hospital Oslo NorwayDepartment of Gastrointestinal Surgery Haukeland University Hospital Bergen NorwayDepartment of Gastrointestinal Surgery, St Olav Hospital Trondheim University Hospital Trondheim NorwayDepartment of Clinical Medicine University of Bergen Bergen NorwayDepartment of Hepatobiliary and Pancreatic Surgery Oslo University Hospital Oslo NorwayDepartment of Gastrointestinal Surgery University Hospital of North Tromsø NorwayDepartment of Clinical Medicine University of Bergen Bergen NorwayInstitute of Clinical Medicine Arctic University of Norway Tromsø NorwayBackground Centralization of pancreatic surgery is currently called for owing to superior outcomes in higher‐volume centres. Conversely, organizational and patient concerns speak for a moderation in centralization. Consensus on the optimal balance has not yet been reached. This observational study presents a volume–outcome analysis of a complete national cohort in a health system with long‐standing centralization. Methods Data for all pancreatoduodenectomies in Norway in 2015 and 2016 were identified through a national quality registry and completed through electronic patient journals. Hospitals were dichotomized (high‐volume (40 or more procedures/year) or medium–low‐volume). Results Some 394 procedures were performed (201 in high‐volume and 193 in medium–low‐volume units). Major postoperative complications occurred in 125 patients (31·7 per cent). A clinically relevant postoperative pancreatic fistula occurred in 66 patients (16·8 per cent). Some 17 patients (4·3 per cent) died within 90 days, and the failure‐to‐rescue rate was 13·6 per cent (17 of 125 patients). In multivariable comparison with the high‐volume centre, medium–low‐volume units had similar overall complication rates, lower 90‐day mortality (odds ratio 0·24, 95 per cent c.i. 0·07 to 0·82) and no tendency for a higher failure‐to‐rescue rate. Conclusion Centralization beyond medium volume will probably not improve on 90‐day mortality or failure‐to‐rescue rates after pancreatoduodenectomy.https://doi.org/10.1002/bjs5.50342 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
L. S. Nymo D. Kleive K. Waardal E. A. Bringeland J. A. Søreide K. J. Labori K. E. Mortensen K. Søreide K. Lassen |
spellingShingle |
L. S. Nymo D. Kleive K. Waardal E. A. Bringeland J. A. Søreide K. J. Labori K. E. Mortensen K. Søreide K. Lassen Centralizing a national pancreatoduodenectomy service: striking the right balance BJS Open |
author_facet |
L. S. Nymo D. Kleive K. Waardal E. A. Bringeland J. A. Søreide K. J. Labori K. E. Mortensen K. Søreide K. Lassen |
author_sort |
L. S. Nymo |
title |
Centralizing a national pancreatoduodenectomy service: striking the right balance |
title_short |
Centralizing a national pancreatoduodenectomy service: striking the right balance |
title_full |
Centralizing a national pancreatoduodenectomy service: striking the right balance |
title_fullStr |
Centralizing a national pancreatoduodenectomy service: striking the right balance |
title_full_unstemmed |
Centralizing a national pancreatoduodenectomy service: striking the right balance |
title_sort |
centralizing a national pancreatoduodenectomy service: striking the right balance |
publisher |
Oxford University Press |
series |
BJS Open |
issn |
2474-9842 |
publishDate |
2020-10-01 |
description |
Background Centralization of pancreatic surgery is currently called for owing to superior outcomes in higher‐volume centres. Conversely, organizational and patient concerns speak for a moderation in centralization. Consensus on the optimal balance has not yet been reached. This observational study presents a volume–outcome analysis of a complete national cohort in a health system with long‐standing centralization. Methods Data for all pancreatoduodenectomies in Norway in 2015 and 2016 were identified through a national quality registry and completed through electronic patient journals. Hospitals were dichotomized (high‐volume (40 or more procedures/year) or medium–low‐volume). Results Some 394 procedures were performed (201 in high‐volume and 193 in medium–low‐volume units). Major postoperative complications occurred in 125 patients (31·7 per cent). A clinically relevant postoperative pancreatic fistula occurred in 66 patients (16·8 per cent). Some 17 patients (4·3 per cent) died within 90 days, and the failure‐to‐rescue rate was 13·6 per cent (17 of 125 patients). In multivariable comparison with the high‐volume centre, medium–low‐volume units had similar overall complication rates, lower 90‐day mortality (odds ratio 0·24, 95 per cent c.i. 0·07 to 0·82) and no tendency for a higher failure‐to‐rescue rate. Conclusion Centralization beyond medium volume will probably not improve on 90‐day mortality or failure‐to‐rescue rates after pancreatoduodenectomy. |
url |
https://doi.org/10.1002/bjs5.50342 |
work_keys_str_mv |
AT lsnymo centralizinganationalpancreatoduodenectomyservicestrikingtherightbalance AT dkleive centralizinganationalpancreatoduodenectomyservicestrikingtherightbalance AT kwaardal centralizinganationalpancreatoduodenectomyservicestrikingtherightbalance AT eabringeland centralizinganationalpancreatoduodenectomyservicestrikingtherightbalance AT jasøreide centralizinganationalpancreatoduodenectomyservicestrikingtherightbalance AT kjlabori centralizinganationalpancreatoduodenectomyservicestrikingtherightbalance AT kemortensen centralizinganationalpancreatoduodenectomyservicestrikingtherightbalance AT ksøreide centralizinganationalpancreatoduodenectomyservicestrikingtherightbalance AT klassen centralizinganationalpancreatoduodenectomyservicestrikingtherightbalance |
_version_ |
1721552653874364416 |