Relation between hospital surgical volume and outcome for pancreatic resection for neoplasm in a publicly funded health care system

Recent studies from the United States have shown that institutions with higher numbers of pancreatic resection procedures for neoplasm have lower mortality rates associated with this procedure. However, minimal work has been done to assess whether the results of similar volume-outcome studies within...

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Bibliographic Details
Published in:Canadian Medical Association journal 1999-03, Vol.160 (5), p.643-648
Main Authors: Simunovic, M, To, T, Theriault, M, Langer, B
Format: Article
Language:English
Subjects:
Aged
Evaluation
Female
Hospital Mortality
Hospitals
Hospitals - statistics & numerical data
Humans
Length of Stay - statistics & numerical data
Male
Middle Aged
Nursing
Odds Ratio
Ontario
Outcome Assessment (Health Care)
Pancreatectomy - mortality
Pancreatectomy - statistics & numerical data
Pancreatic cancer
Pancreatic Neoplasms - surgery
Regression Analysis
Retrospective Studies
Risk Factors
Statistics
Surgery
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Summary:Recent studies from the United States have shown that institutions with higher numbers of pancreatic resection procedures for neoplasm have lower mortality rates associated with this procedure. However, minimal work has been done to assess whether the results of similar volume-outcome studies within a publicly financed health care system would differ from those obtained in a mixed public-private health care system. A population-based retrospective analysis was used to examine pancreatic resection for neoplasm in Ontario for the period 1988/89 to 1994/95. Outcomes examined included in-hospital case fatality rate and mean length of stay in hospital. For each hospital, total procedure volume for the study period was defined as low (fewer than 22), medium (22-42) or high (more than 42). Regression models were used to measure volume-outcome relations. The likelihood of postoperative death was higher in low-volume and medium-volume centres than in high-volume centres (odds ratio 5.1 and 4.5 respectively; p < 0.01 for both). Mean length of stay was greater in low- and medium-volume centres than in high-volume centres (by 7.7 and 9.2 days respectively, p < 0.01 for both). This study adds to growing evidence that, for pancreatic resection for neoplasm, patients may have better outcomes if they are treated in high-volume hospitals rather than low-volume hospitals.
ISSN:0008-4409
0820-3946
1488-2329