Does surgical volume trump disparities in predicting outcomes following hepatopancreaticobiliary (HPB) surgery?

Abstract

Background: Research has shown that high volume hospitals (HVH) are associated with improved outcomes following HPB surgery. It has also been shown that health care disparities can also contribute to outcomes following HPB surgery. The purpose of this study is to examine outcomes following HPB surgery in a HVH which services a population of patients at significant risk for health care disparities. Methods: A retrospective analysis of patients undergoing HPB surgical procedure at a single high volume HPB center from 2012 to 17 was performed. National Surgical Quality Improvement Program (NSQIP) data on the cohort of patients included in the univariate analysis were analyzed to determine if gender, race, insurance status, distance to nearest HVH, primary care physician (PCP) access, rural versus urban population, and history of mental illness were associated with outcome(s). Results: One hundred eighty-two patients were included in this study. There was no statistical difference in outcome(s) in regards to the presence of leak rates, post-operative infections, pulmonary complications, cardiovascular complications, transfusions, death within 30 days, death after 30 days, unplanned return to the OR, and 30 day readmission rate in any population of patients analyzed by univariate analysis. PCP access and gender; however, did have an impact on length of stay (LOS). The presence of a PCP for follow-up was associated with a significant decrease in LOS (11 vs 20 days; P = 0.013). Female gender was also associated with a decrease in LOS (9 vs 15 days; P = 0.009). Conclusion: In our cohort of patients, perioperative outcomes following HPB surgery appear to be mostly independent of risk factors for health care disparities including race, insurance status, distance to nearest HVH, rural population and history of mental illness.