How high is a high-volume pancreatic surgery centre?

Abstract

Introduction: There has been increasing interest in the concept of volume-outcome relationships for pancreatic surgeries and studies have demonstrated improved surgical outcomes in such “high-volume centres”, however, there remains no standardised definition of what exactly constitutes a “high-volume centre”. The aim was to determine the prevalence of the use of the term “high-volume centre” and to assess the variability in its definition. Method: A systematic review of PubMed using the search phrase “high AND volume AND pancreas” for publications between 2012-2017 was performed. Publications specifically assessing hospital volume for pancreatic resections as a variable were then further assessed to determine their definition of “high-volume centre”. Result: “High-volume” was mentioned in 131 publications, of which, the authors of 62 publications identified as belonging to a high-volume centre. Definitions, or data enabling the calculation of hospital volume, were provided in 67 publications. There were 32 publications from 6 countries (USA, Germany, Australia, Italy, France, Japan) specifically assessing hospital-volume as a variable. The definitions of a “high-volume centre” varied widely (range ≥ 10 to > 65 pancreatic resections per year), with 5 articles not detailing their meaning of “high-volume centre”. The reference points also varied, with some studies assessing “all pancreatic operations / attempted pancreatic resections per year” (15) while others specifically measured “pancreatic cancer resections per year” (17). Conclusion: Significant heterogeneity exists about what is meant by “high-volume centre” for pancreatic surgery. Factors that influence the “surgical volume” of a given centre include (1) population / population density (2) local disease prevalence (3) number of healthcare facilities in a given area, (4) local referral patterns, and (5) experience in both benign and malignant disease. While there are institutions that are undoubtedly high-volume centres, critical analysis must be used to determine what exactly is meant by the term in the scientific literature to place it in context.