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dc.contributor.authorNymo, Linn Såve
dc.contributor.authorKleive, Dyre
dc.contributor.authorWaardal, Kim
dc.contributor.authorBringeland, Erling Audun
dc.contributor.authorSøreide, Jon Arne
dc.contributor.authorLabori, Knut Jørgen
dc.contributor.authorMortensen, Kim Erlend
dc.contributor.authorSøreide, Kjetil
dc.contributor.authorLassen, Kristoffer
dc.date.accessioned2020-12-04T09:27:48Z
dc.date.available2020-12-04T09:27:48Z
dc.date.issued2020-09-07
dc.description.abstract<i>Background</i> - 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.<p> <p>Methods</i> - 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).<p> <p>Results</i> - 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.<p> <p><i>Conclusion</i> - Centralization beyond medium volume will probably not improve on 90‐day mortality or failure‐to‐rescue rates after pancreatoduodenectomy.en_US
dc.identifier.citationNymo, Kleive, Waardal, Bringeland, Søreide, Labori, Mortensen, Søreide, Lassen. Centralizing a national pancreatoduodenectomy service: striking the right balance. BJS Open. 2020;4(5):904-913en_US
dc.identifier.cristinIDFRIDAID 1853762
dc.identifier.doi10.1002/bjs5.50342
dc.identifier.issn2474-9842
dc.identifier.urihttps://hdl.handle.net/10037/19986
dc.language.isoengen_US
dc.publisherOxford University Pressen_US
dc.relation.ispartofNymo, 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). <a href=https://hdl.handle.net/10037/22737>https://hdl.handle.net/10037/22737</a>.
dc.relation.journalBJS Open
dc.rights.accessRightsopenAccessen_US
dc.rights.holderCopyright 2020 The Author(s)en_US
dc.subjectVDP::Medical disciplines: 700::Basic medical, dental and veterinary science disciplines: 710en_US
dc.subjectVDP::Medisinske Fag: 700::Basale medisinske, odontologiske og veterinærmedisinske fag: 710en_US
dc.titleCentralizing a national pancreatoduodenectomy service: striking the right balanceen_US
dc.type.versionpublishedVersionen_US
dc.typeJournal articleen_US
dc.typeTidsskriftartikkelen_US
dc.typePeer revieweden_US


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