Is Illinois heeding the call to regionalize pancreatic surgery?

Authors

  • Amanda V. Hayman MD, MPH,

    1. Department of Surgery, Northwestern University Feinberg School of Medicine, Jesse Brown VA Medical Center, Chicago, Illinios
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  • Matthew J. Fisher BA,

    1. Department of Surgery, Northwestern University Feinberg School of Medicine, Jesse Brown VA Medical Center, Chicago, Illinios
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  • Thomas Kluz BS,

    1. Department of Surgery, Northwestern University Feinberg School of Medicine, Jesse Brown VA Medical Center, Chicago, Illinios
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  • Ryan P. Merkow MD,

    1. Department of Surgery, Northwestern University Feinberg School of Medicine, Jesse Brown VA Medical Center, Chicago, Illinios
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  • Edward C. Wang PhD,

    1. Department of Surgery, Northwestern University Feinberg School of Medicine, Jesse Brown VA Medical Center, Chicago, Illinios
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  • David J. Bentrem MD, MSCI

    Corresponding author
    1. Department of Surgery, Northwestern University Feinberg School of Medicine, Jesse Brown VA Medical Center, Chicago, Illinios
    • 676 N. St. Clair, Suite 650, Chicago, IL 60611. Fax: 312-695-1462.===

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  • Presented at the 2011 Academic Surgical Congress annual meeting, Huntington Beach, CA.

Abstract

Background and Objectives

Recommendations to refer pancreatic procedures to high-volume centers have been in place for a decade. We sought to determine whether regionalization of pancreatic procedures to high-volume centers is occurring in Illinois.

Methods

We compared pancreatic procedures performed in Illinois hospitals from 2000 to 2004 [time period (TP) 1] versus 2005–2009 (TP2) for changes in inpatient mortality and hospital volume. Hospitals were categorized into low- (LVH), intermediate- (IVH), or high-volume (HVH).

Results

From TP1 to TP2, there was a 23% increase in absolute case volume (2,232–2,737), despite fewer hospitals performing pancreatic procedures (114–95). In hospital mortality decreased (5.5–3.3%, P < 0.01) and was lowest at HVHs. LVHs and IVHs were associated with a 4.7 and 3.0 higher odds of mortality, respectively (both P < 0.001). Overall, HVHs performed 659 (+73%) more procedures, whereas cumulative procedure volume dropped by 154 cases at LVHs (+1%) and IVHs (−18%).

Conclusions

We observed limited evidence of regionalization of pancreatic procedures in Illinois. The increase in HVH case volume cannot be solely attributed to regionalization, given the corresponding modest decrease seen at non-HVHs. There is opportunity for Illinois hospitals to implement strategies such as selective referral to improve mortality after pancreatic resection. J. Surg. Oncol. 2013;107:685–691. © 2013 Wiley Periodicals, Inc.

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