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The Effect of Hospital Versus Surgeon Volume on Short-Term Patient Outcomes After Pancreaticoduodenectomy: a SEER–Medicare Analysis

  • Pancreatic Tumors
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Abstract

Background

The volume-outcome relationship has been well-established for pancreaticoduodenectomy (PD). It remains unclear if this is primarily driven by hospital volume or individual surgeon experience.

Objective

This study aimed to determine the relationship of hospital and surgeon volume on short-term outcomes of patients with pancreatic adenocarcinoma undergoing PD.

Methods

Patients >65 years of age who underwent PD for pancreatic adenocarcinoma were identified from the Surveillance, Epidemiology, and End Results (SEER)–Medicare database (2008–2015). Analyses were stratified by hospital volume and then surgeon volume, creating four volume cohorts: low-low (low hospital, low surgeon), low-high (low hospital, high surgeon), high-low (high hospital, low surgeon), high-high (high hospital, high surgeon). Propensity scores were created for the odds of undergoing surgery with high-volume surgeons. Following matching, multivariable analysis was used to assess the impact of surgeon volume on outcomes within each hospital volume cohort.

Results

In total, 2450 patients were identified: 54.3% were treated at high-volume hospitals (27.0% low-volume surgeons, 73.0% high-volume surgeons) and 45.7% were treated at low-volume hospitals (76.9% low-volume surgeons, 23.1% high-volume surgeons). On matched multivariable analysis, there were no significant differences in the risk of major complications, 90-day mortality, and 30-day readmission based on surgeon volume within the low and high hospital volume cohorts.

Conclusion

Compared with surgeon volume, hospital volume is a more significant factor in predicting short-term outcomes after PD. This suggests that a focus on resources and care pathways, in combination with volume metrics, is more likely to achieve high-quality care for patients undergoing PD across all hospitals.

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Funding

Marianna Papageorge is supported by a T32 Grant through Boston University School of Medicine (award #T32HP10028), and Alison Woods is supported by a T32 grant through Johns Hopkins University School of Medicine, from the National Institutes of Health (National Cancer Institute award #T32CA126607). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NIH and supporting institutions.

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Authors and Affiliations

  1. Department of Surgery, Boston Medical Center, Boston University School of Medicine, Boston, MD, USA

    Marianna V. Papageorge MD, Susanna W. L. de Geus MD, PhD, Alison P. Woods MD, Sing Chau Ng MS, David McAneny MD, Jennifer F. Tseng MD, MPH, Kelly M. Kenzik PhD & Teviah E. Sachs MD, MPH

  2. Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Alison P. Woods MD

  3. Division of Hematology and Oncology, University of Alabama at Birmingham, Birmingham, AL, USA

    Kelly M. Kenzik PhD

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  1. Marianna V. Papageorge MD
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  2. Susanna W. L. de Geus MD, PhD
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  8. Teviah E. Sachs MD, MPH
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Correspondence to Teviah E. Sachs MD, MPH.

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Disclosure

Marianna V. Papageorge, Susanna W.L. de Geus, Alison P. Woods, Sing Chau Ng, David McAneny, Jennifer F. Tseng, Kelly M. Kenzik, and Teviah E. Sachs have no conflicts of interest to disclose.

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Papageorge, M.V., de Geus, S.W.L., Woods, A.P. et al. The Effect of Hospital Versus Surgeon Volume on Short-Term Patient Outcomes After Pancreaticoduodenectomy: a SEER–Medicare Analysis. Ann Surg Oncol 29, 2444–2451 (2022). https://doi.org/10.1245/s10434-021-11196-3

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  • DOI: https://doi.org/10.1245/s10434-021-11196-3

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