Modelling centralization of pancreatic surgery in a nationwide analysis

Background The benefits of centralization of pancreatic surgery have been documented, but policy differs between countries. This study aimed to model various centralization criteria for their effect on a nationwide cohort. Methods Data on all pancreatic resections performed between 2014 and 2016 wer...

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Published in:British journal of surgery 2020-10, Vol.107 (11), p.1510-1519
Main Authors: Balzano, G., Guarneri, G., Pecorelli, N., Paiella, S., Rancoita, P. M. V., Bassi, C., Falconi, M.
Format: Article
Language:English
Subjects:
Adult
Aged
Aged, 80 and over
Centralized Hospital Services - organization & administration
Centralized Hospital Services - statistics & numerical data
Female
Health Policy
Hospital Mortality
Hospitals, High-Volume - statistics & numerical data
Hospitals, Low-Volume - organization & administration
Hospitals, Low-Volume - statistics & numerical data
Humans
Italy
Male
Middle Aged
Models, Organizational
Mortality
Outcome Assessment, Health Care
Pancreas
Pancreatectomy - mortality
Pancreaticoduodenectomy - mortality
Quality Improvement - organization & administration
Quality Indicators, Health Care
Surgery
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Summary:Background The benefits of centralization of pancreatic surgery have been documented, but policy differs between countries. This study aimed to model various centralization criteria for their effect on a nationwide cohort. Methods Data on all pancreatic resections performed between 2014 and 2016 were obtained from the Italian Ministry of Health. Mortality was assessed for different hospital volume categories and for each individual facility. Observed mortality and risk‐standardized mortality rate (RSMR) were calculated. Various models of centralization were tested by applying volume criteria alone or in combination with mortality thresholds. Results A total of 395 hospitals performed 12 662 resections; 305 hospitals were in the very low‐volume category (mean 2·6 resections per year). The nationwide mortality rate was 6·2 per cent, increasing progressively from 3·1 per cent in very high‐volume to 10·6 per cent in very low‐volume hospitals. For the purposes of centralization, applying a minimum volume threshold of at least ten resections per year would lead to selection of 92 facilities, with an overall mortality rate of 5·3 per cent. However, the mortality rate would exceed 5 per cent in 48 hospitals and be greater than 10 per cent in 17. If the minimum volume were 25 resections per year, the overall mortality rate would be 4·7 per cent in 38 facilities, but still over 5 per cent in 17 centres and more than 10 per cent in five. The combination of a volume requirement (at least 10 resections per year) with a mortality threshold (maximum RSMR 5 or 10 per cent) would allow exclusion of facilities with unacceptable results, yielding a lower overall mortality rate (2·7 per cent in 45 hospitals or 4·2 per cent in 76 respectively). Conclusion The best performance model for centralization involved a threshold for volume combined with a mortality threshold. Antecedentes Los beneficios de la centralización de la cirugía pancreática están bien documentados, pero la política de actuación difiere entre los países. Este estudio tuvo como objetivo desarrollar modelos de centralización basados en varios criterios y analizar su aplicación en una cohorte nacional. Métodos Los datos de todas las resecciones pancreáticas realizadas entre 2014 y 2016 se obtuvieron del Ministerio de Salud italiano. La mortalidad se evaluó para diferentes categorías del volumen hospitalario y para cada centro individualmente. Se calculó la mortalidad observada y la tasa estandarizada de riesgo de
ISSN:0007-1323
1365-2168
DOI:10.1002/bjs.11716