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Centralizing a national pancreatoduodenectomy service: striking the right balance

Permanent link
https://hdl.handle.net/10037/19986
DOI
https://doi.org/10.1002/bjs5.50342
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Date
2020-09-07
Type
Journal article
Tidsskriftartikkel
Peer reviewed

Author
Nymo, Linn Såve; Kleive, Dyre; Waardal, Kim; Bringeland, Erling Audun; Søreide, Jon Arne; Labori, Knut Jørgen; Mortensen, Kim Erlend; Søreide, Kjetil; Lassen, Kristoffer
Abstract
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.

Is part of
Nymo, L.S. (2021). Wuthering heights: Outcomes from pancreatic surgery and trends in treatment of pancreatic ductal adenocarcinoma in Norway in a post-centralization era. (Doctoral thesis). https://hdl.handle.net/10037/22737.
Publisher
Oxford University Press
Citation
Nymo, Kleive, Waardal, Bringeland, Søreide, Labori, Mortensen, Søreide, Lassen. Centralizing a national pancreatoduodenectomy service: striking the right balance. BJS Open. 2020;4(5):904-913
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  • Artikler, rapporter og annet (klinisk medisin) [1974]
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