Relative impact of surgeon and hospital volume on operative mortality and complications following pancreatic resection in Medicare patients

Abstract Background Surgeon and hospital volume are both known to affect outcomes for patients undergoing pancreatic resection. The objective was to evaluate the relative effects of surgeon and hospital volume on 30-d mortality and 30-d complications after pancreatic resection among older patients....

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Published in:The Journal of surgical research 2016-08, Vol.204 (2), p.326-334
Main Authors: Mehta, Hemalkumar B., PhD, Parmar, Abhishek D., MD, MS, Adhikari, Deepak, MS, Tamirisa, Nina P., MD, MS, Dimou, Francesca, MD, Jupiter, Daniel, PhD, Riall, Taylor S., MD, PhD
Format: Article
Language:English
Subjects:
Aged
Aged, 80 and over
Complications
Female
Hospital volume
Hospitals - statistics & numerical data
Humans
Logistic Models
Male
Medicare
Mortality
Multilevel models
Pancreatectomy - mortality
Pancreatic resection
Postoperative Complications - epidemiology
Retrospective Studies
Surgeon volume
Surgeons - statistics & numerical data
Surgery
Texas - epidemiology
United States
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Summary:Abstract Background Surgeon and hospital volume are both known to affect outcomes for patients undergoing pancreatic resection. The objective was to evaluate the relative effects of surgeon and hospital volume on 30-d mortality and 30-d complications after pancreatic resection among older patients. Materials and methods The study used Texas Medicare data (2000-2012), identifying high-volume surgeons as those performing ≥4 pancreatic resections/year, and high-volume hospitals as those performing ≥11 pancreatic resections/year, on Medicare patients. Three-level hierarchical logistic regression models were used to evaluate the relative effects of surgeon and hospital volumes on mortality and complications, after adjusting for case mix differences. Results There were 2453 pancreatic resections performed by 490 surgeons operating in 138 hospitals. Of the total, 4.5% of surgeons and 6.5% of hospitals were high volume. The overall 30-d mortality was 9.0%, and the 30-d complication rate was 40.6%. Overall, 8.9% of the variance in 30-d mortality was attributed to surgeon factors and 9.8% to hospital factors. For 30-d complications, 4.7% of the variance was attributed to surgeon factors and 1.2% to hospital factors. After adjusting for patient, surgeon, and hospital characteristics, high surgeon volume (odds ratio [OR] = 0.54, 95% confidence interval [CI], 0.33-0.87) and high hospital volume (OR = 0.52; 95% CI, 0.30-0.92) were associated with lower risk of mortality; high surgeon volume (OR = 0.71, 95% CI, 0.55-0.93) was also associated lower risk of 30-d complications. Conclusions Both hospital and surgeon factors contributed significantly to the observed variance in mortality, but only surgeon factors impacted complications.
ISSN:0022-4804
1095-8673
DOI:10.1016/j.jss.2016.05.008