High Volume Center for Distal Pancreatectomy

Abstract

Introduction: The association between high procedural volume and improved outcomes is generally accepted for most high risk,low volume procedures,such as pancreatic or esophageal surgery,which supports the beneficial effects of the concentration of these procedures in high-volume centers.Several cutoffs have been reported to define a high-volume center for pancreatic surgery; however,the definition of high-volume center for distal pancreatectomy still needs to be determined.The purpose of this study was to evaluate the association between hospital-procedure-volume and patient mortality for patients undergoing distal pancreatectomy using a large database to determine an evidence-based threshold of hospital-volume associated with improvement in postoperative mortality. Methods: Patients who underwent distal pancreatectomy were identified using the National Cancer Database (2004-2015). Logistic regression analysis and restricted cubic spline regression analysis was performed to determine the linear and non-linear association between mean hospital-volume and mean 90-day mortality. Results: 13307 patients underwent distal pancreatectomy at 1081 unique hospitals. 30 and 90-day mortality of the study population were 1.77% (n=236) and 4.07%(n=542), respectively.Baseline characteristics and mean annual mortality of individual hospitals were determined. A logistic regression analysis was performed,which demonstrated that institutional volume is significantly associated with decreased 90-day mortality.The maximum improvement in 90-day mortality was seen if the annual hospital volume was greater than 6 (p< 0.0001, OR=2.057(1.697-2.493)).The non-linear association demonstrated continued improvement in 90-day mortality with an increase in average hospital-volume (Fig1). Conclusion: This data suggests that hospital-volume has a direct impact on 90-day mortality after distal pancreatectomy.Based on our results, we recommend defining a high volume center as hospitals performing seven or more distal pancreatectomy cases/year.