Skip to main content
Erschienen in: Annals of Surgical Oncology 13/2018

05.09.2018 | Health Services Research and Global Oncology

Quality Comes with the (Anatomic) Territory: Evaluating the Impact of Surgeon Operative Mix on Patient Outcomes After Pancreaticoduodenectomy

verfasst von: Krista Hachey, MD, MPH, Ryan Morgan, BS, Amy Rosen, PhD, Sowmya R. Rao, PhD, David McAneny, MD, Jennifer Tseng, MD, MPH, Gerard Doherty, MD, Teviah Sachs, MD, MPH

Erschienen in: Annals of Surgical Oncology | Ausgabe 13/2018

Einloggen, um Zugang zu erhalten

Abstract

Background

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.

Methods

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.

Results

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 < 0.001). Increasing OM volume was associated with decreased inpatient mortality, shorter hospital stay, and lower likelihood of any postoperative complication, using unadjusted regression (all p < 0.001). Adjusted regression results indicated that increasing OM volume is a significant predictor of decreased odds of a prolonged hospital stay (odds ratio [OR] 0.81; 95% confidence interval [CI] 0.73–0.90; p < 0.001).

Conclusions

Surgeon PD volume is an important predictor of outcomes after PD. However, surgeon OM volume identifies a subset of lower-PD-volume surgeons with more favorable outcomes.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. NEJM. 2002;346:1128–37.CrossRef Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, et al. Hospital volume and surgical mortality in the United States. NEJM. 2002;346:1128–37.CrossRef
2.
Zurück zum Zitat Finlayson EV, Goodney PP, Birkmeyer JD. Hospital volume and operative mortality in cancer surgery: a national study. Arch Surg. 2003;138:721–25.CrossRef Finlayson EV, Goodney PP, Birkmeyer JD. Hospital volume and operative mortality in cancer surgery: a national study. Arch Surg. 2003;138:721–25.CrossRef
3.
Zurück zum Zitat Dimick JB, Pronovost PJ, Cowan JA, Lipsett PA, Stanley JC, Upchurch GR. Variation in postoperative complication rates after high-risk surgery in the United States. Surgery. 2003;134:534–41.CrossRef Dimick JB, Pronovost PJ, Cowan JA, Lipsett PA, Stanley JC, Upchurch GR. Variation in postoperative complication rates after high-risk surgery in the United States. Surgery. 2003;134:534–41.CrossRef
4.
Zurück zum Zitat Reames BN, Ghaferi AA, Birkmeyer JD, Dimick JB. Hospital volume and operative mortality in the modern era. Ann Surg. 2014;260:244–51.CrossRef Reames BN, Ghaferi AA, Birkmeyer JD, Dimick JB. Hospital volume and operative mortality in the modern era. Ann Surg. 2014;260:244–51.CrossRef
5.
Zurück zum Zitat Fong Y, Gonen M, Rubin D, Radzyner M, Brennan MF. Long-term survival is superior after resection for cancer in high-volume centers. Ann Surg. 2005;242:540–4.PubMedPubMedCentral Fong Y, Gonen M, Rubin D, Radzyner M, Brennan MF. Long-term survival is superior after resection for cancer in high-volume centers. Ann Surg. 2005;242:540–4.PubMedPubMedCentral
6.
Zurück zum Zitat Hata T, Motoi F, Ishida M, Naitoh T, Katayose Y, Egawa S, et al. Effect of hospital volume on surgical outcomes after pancreaticoduodenectomy: a systematic review and meta-analysis. Ann Surg. 2016;263:664–72.CrossRef Hata T, Motoi F, Ishida M, Naitoh T, Katayose Y, Egawa S, et al. Effect of hospital volume on surgical outcomes after pancreaticoduodenectomy: a systematic review and meta-analysis. Ann Surg. 2016;263:664–72.CrossRef
7.
Zurück zum Zitat Boudourakis LD, Wang TS, Roman SA, Desai R, Sosa JA. Evolution of the surgeon-volume, patient-outcome relationship. Ann Surg. 2009;250:159–65.CrossRef Boudourakis LD, Wang TS, Roman SA, Desai R, Sosa JA. Evolution of the surgeon-volume, patient-outcome relationship. Ann Surg. 2009;250:159–65.CrossRef
8.
Zurück zum Zitat Burwell SM. Setting value-based payment goals: HHS efforts to improve US health care. N Engl J Med. 2015;372:897–9.CrossRef Burwell SM. Setting value-based payment goals: HHS efforts to improve US health care. N Engl J Med. 2015;372:897–9.CrossRef
9.
Zurück zum Zitat Schneider EB, Hyder O, Wolfgang CL, Dodson RM, Haider AH, Herman JM, et al. Provider versus patient factors impacting hospital length of stay after pancreaticoduodenectomy. Surgery. 2013;154:152–61.CrossRef Schneider EB, Hyder O, Wolfgang CL, Dodson RM, Haider AH, Herman JM, et al. Provider versus patient factors impacting hospital length of stay after pancreaticoduodenectomy. Surgery. 2013;154:152–61.CrossRef
10.
Zurück zum Zitat Birkmeyer JD, Finlayson SR, Tosteson AN, Sharp SM, Warshaw AL, Fisher ES. Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery. 1999;125:250–6.CrossRef Birkmeyer JD, Finlayson SR, Tosteson AN, Sharp SM, Warshaw AL, Fisher ES. Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery. 1999;125:250–6.CrossRef
11.
Zurück zum Zitat Birkmeyer JD. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349:2117–27.CrossRef Birkmeyer JD. Surgeon volume and operative mortality in the United States. N Engl J Med. 2003;349:2117–27.CrossRef
12.
Zurück zum Zitat Enomoto LM, Gusani NJ, Dillon PW, Hollenbeak CS. Impact of surgeon and hospital volume on mortality, length of stay, and cost of pancreaticoduodenectomy. J Gastrointest Surg. 2014;18:690–700.CrossRef Enomoto LM, Gusani NJ, Dillon PW, Hollenbeak CS. Impact of surgeon and hospital volume on mortality, length of stay, and cost of pancreaticoduodenectomy. J Gastrointest Surg. 2014;18:690–700.CrossRef
13.
Zurück zum Zitat Toomey PG, Teta AF, Patel KD, Ross SB, Rosemurgy AS. High-volume surgeons vs high-volume hospitals: are best outcomes more due to who or where? Am J Surg. 2016:211:59–63.CrossRef Toomey PG, Teta AF, Patel KD, Ross SB, Rosemurgy AS. High-volume surgeons vs high-volume hospitals: are best outcomes more due to who or where? Am J Surg. 2016:211:59–63.CrossRef
14.
Zurück zum Zitat Al-Refaie WB, Muluneh B, Zhong W, Parsons HM, Tuttle TM, Vickers SM, et al. Who receives their complex cancer surgery at low-volume hospitals? J Am Coll Surg. 2012;214:81–7.CrossRef Al-Refaie WB, Muluneh B, Zhong W, Parsons HM, Tuttle TM, Vickers SM, et al. Who receives their complex cancer surgery at low-volume hospitals? J Am Coll Surg. 2012;214:81–7.CrossRef
15.
Zurück zum Zitat Chang DC, Zhang Y, Mukherjee D, Wolfgang CL, Schulick RD, Cameron JL, et al. Variations in referral patterns to high-volume centers for pancreatic cancer. J Am Coll Surg. 2009;109:720–26.CrossRef Chang DC, Zhang Y, Mukherjee D, Wolfgang CL, Schulick RD, Cameron JL, et al. Variations in referral patterns to high-volume centers for pancreatic cancer. J Am Coll Surg. 2009;109:720–26.CrossRef
16.
Zurück zum Zitat Riall TS, Eschbach KA, Townsend C, Goodwin JS. Trends and disparities in regionalization of pancreatic resection. J Gastrointest Surg. 2007;11:1242–52.CrossRef Riall TS, Eschbach KA, Townsend C, Goodwin JS. Trends and disparities in regionalization of pancreatic resection. J Gastrointest Surg. 2007;11:1242–52.CrossRef
17.
Zurück zum Zitat Epstein AJ, Gray BH, Schlesinger M. Racial and ethnic differences in the use of high-volume hospitals and surgeons. Arch Surg. 2010;145:179–86.CrossRef Epstein AJ, Gray BH, Schlesinger M. Racial and ethnic differences in the use of high-volume hospitals and surgeons. Arch Surg. 2010;145:179–86.CrossRef
18.
Zurück zum Zitat Liu JH, Zingmond DS, McGory ML, SooHoo NF, Ettner SL, Brook RH, et al. Disparities in the utilization of high-volume hospitals for complex surgery. JAMA. 2006;296:1973–80.CrossRef Liu JH, Zingmond DS, McGory ML, SooHoo NF, Ettner SL, Brook RH, et al. Disparities in the utilization of high-volume hospitals for complex surgery. JAMA. 2006;296:1973–80.CrossRef
19.
Zurück zum Zitat Massarweh NN, Flum DR, Symons RG, Varghese TK, Pellegrini CA. A critical evaluation of the impact of Leapfrog’s evidence-based hospital referral. J Am Coll Surg. 2011; 212:150–59.CrossRef Massarweh NN, Flum DR, Symons RG, Varghese TK, Pellegrini CA. A critical evaluation of the impact of Leapfrog’s evidence-based hospital referral. J Am Coll Surg. 2011; 212:150–59.CrossRef
20.
Zurück zum Zitat Sachs TE, Ejaz A, Weiss M, Spolverato G, Ahuja N, Makary MA, et al. Assessing the experience in complex hepatopancreatobiliary surgery among graduating chief residents: is the operative experience enough? Surgery. 2014;156:385–93.CrossRef Sachs TE, Ejaz A, Weiss M, Spolverato G, Ahuja N, Makary MA, et al. Assessing the experience in complex hepatopancreatobiliary surgery among graduating chief residents: is the operative experience enough? Surgery. 2014;156:385–93.CrossRef
21.
Zurück zum Zitat Sachs TE, Pawlik TM. See one, do one, and teach none: resident experience as a teaching assistant. J Surg Res. 2015;195:44–51.CrossRef Sachs TE, Pawlik TM. See one, do one, and teach none: resident experience as a teaching assistant. J Surg Res. 2015;195:44–51.CrossRef
22.
Zurück zum Zitat Bellal J, Morton JM, Hernandez-Boussard T, Rubinfeld I, Faraj C, Velanovich V. Relationship between hospital volume, system clinical resources, and mortality in pancreatic resection. J Am Coll Surg. 2009;208:520–7.CrossRef Bellal J, Morton JM, Hernandez-Boussard T, Rubinfeld I, Faraj C, Velanovich V. Relationship between hospital volume, system clinical resources, and mortality in pancreatic resection. J Am Coll Surg. 2009;208:520–7.CrossRef
Metadaten
Titel
Quality Comes with the (Anatomic) Territory: Evaluating the Impact of Surgeon Operative Mix on Patient Outcomes After Pancreaticoduodenectomy
verfasst von
Krista Hachey, MD, MPH
Ryan Morgan, BS
Amy Rosen, PhD
Sowmya R. Rao, PhD
David McAneny, MD
Jennifer Tseng, MD, MPH
Gerard Doherty, MD
Teviah Sachs, MD, MPH
Publikationsdatum
05.09.2018
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 13/2018
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-018-6732-y

Weitere Artikel der Ausgabe 13/2018

Annals of Surgical Oncology 13/2018 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.