Centralization of PD and the Effect on Mortality
Centralization of PD and the Effect on Mortality
de Wilde RF, Besselink MG, van der Tweel I, et al; Dutch Pancreatic Cancer Group
Br J Surg. 2012;99:404-410
The aim of this study was to examine the effect of hospital volume on mortality due to pancreatic cancer in The Netherlands. In 2006, a regulation was passed in that country stipulating that pancreaticoduodenectomy (PD) should only be performed in hospitals that had at least 11 annual procedures. Initially, 48 hospitals were performing PDs, but by 2009, the number of hospitals had decreased to 30.
There was an associated reduction in mortality from 9.8% to 5.1% (P = .044) during the study period. The combined mortality rate at the 2 hospitals with an average volume of more than 30 PDs per year was 1.8%, compared with 14.7% in the few remaining hospitals that had a very low volume of PDs.
Over a 5-year period after initiation of a directive aimed at centralizing high-risk surgical procedures to high-volume centers, mortality from PD steadily declined, with the lowest mortality rates occurring in the 2 hospitals that performed more than 30 PDs per year. Clearly, these results strengthen the argument for regionalization of this procedure to high-volume centers. In the United States, about 300 high-volume centers would suffice if PD were performed only in hospitals with more than 30 operations per year.
Abstract
Impact of Nationwide Centralization of Pancreaticoduodenectomy on Hospital Mortality
de Wilde RF, Besselink MG, van der Tweel I, et al; Dutch Pancreatic Cancer Group
Br J Surg. 2012;99:404-410
Summary
The aim of this study was to examine the effect of hospital volume on mortality due to pancreatic cancer in The Netherlands. In 2006, a regulation was passed in that country stipulating that pancreaticoduodenectomy (PD) should only be performed in hospitals that had at least 11 annual procedures. Initially, 48 hospitals were performing PDs, but by 2009, the number of hospitals had decreased to 30.
There was an associated reduction in mortality from 9.8% to 5.1% (P = .044) during the study period. The combined mortality rate at the 2 hospitals with an average volume of more than 30 PDs per year was 1.8%, compared with 14.7% in the few remaining hospitals that had a very low volume of PDs.
Viewpoint
Over a 5-year period after initiation of a directive aimed at centralizing high-risk surgical procedures to high-volume centers, mortality from PD steadily declined, with the lowest mortality rates occurring in the 2 hospitals that performed more than 30 PDs per year. Clearly, these results strengthen the argument for regionalization of this procedure to high-volume centers. In the United States, about 300 high-volume centers would suffice if PD were performed only in hospitals with more than 30 operations per year.
Abstract
