According to the volume-outcome concept the postoperative outcome after major pancreatic surgery in high-volume institutions compares favorably to low- volume centers. However, it is not clear whether this is applicable to all low-volume institutions nowadays. The aim of the study was to evaluate the postoperative outcome after major elective pancreatic surgery in a low- volume academic surgical clinic. All consecutive elective major pancreatic cases operated within a 10-year period till October 2013 have been retrospectively reviewed. During the studied period, 36 patients (15 females, 21 males, mean age 54 years, age range 37-76) were scheduled for elective pancreatic surgery and underwent pancreatic resection (n=31, 18 proximal and 13 distal pancreatic resections) or complete pancreatic duct drainage procedure (n=5). Eleven patients had chronic pancreatitis and 25 patients had malignant or benign tumors. Vascular or adjacent organ resection was performed in 9 patients (29% of resections). The overall postoperative morbidity was 36% (n=13), and complications requiring re-operation occurred in 5 patients (14%). The median postoperative hospital stay was 11 days for patients without complications vs. 25 days for patients with any complication. There was no 60- day postoperative mortality or hospital readmission. Major elective pancreatic surgery can be safely performed today in a low-volume academic general surgical clinic, with postoperative outcomes similar to those reported by high-volume centers.
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1. Klotz H Candinas D Platz A Horvath A Dindo D Schlumpf R et al. Preoperative risk assessment in elective general surgery. Br J Surg. 1996;83912): 1788-99.
2. Dindo D Demartines N Clavien PA. Classification of Surgical Complications. Ann Surg.2004;240(2):205-13.
3. Birkmeyer JD Siewers AE Finlayson EV Stukel T Lucas FL Batista 1 et al. Hospital volume and surgical mortality in the United States. N Eng J Med. 2002; 346(15): 1128-37.
4. Begg CB Cramer LD Hoskins WJ Brennan MF. Impact of hospital volume on operative mortality for major cancer surgery. JAMA. 1998;280(20): 1747-51.
5. Halm EA Lee C Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Annals of Internal Medicine. 2002; 137(6):511-20.
6. Simunovic M Urbach D Major D Sutradhar R Baxter N To T et al. Assessing the volume-outcome hypothesis and region-level quality improvement interventions: pancreas cancer surgery in two Canadian Provinces. Ann Surg Oncol. 2010; 17( 10):2537-44.
7. Schell MT Barcia A Spitzer AL Harris HW. Pancreaticoduodenectomy: Volume is not Associated with outcome within an Academic Health Care System. HPB Surgery. 2008; 2008:825940.
8. LaPar DJ Kron IL Jones DR Stukenborg GJ Kozower BD. Hospital procedure volume should not be used as a measure of surgical quality. Ann Surg. 2012;256(4):606-15.
9. Fisher WE Hodges SE Wu MF Hilsenbeck SG Brunicardi FC. Assessment of the learning curve for pancreaticoduodenectomy. Am J Surg. 2012;203(6):684-90.
10. Rosales-Velderrain A Bowers SP Goldberg RF Clarke TM Buchanan MA Stauffer JA et al. National trends in resection of the distal pancreas. World J Gastroenterol. 2012; 18(32):4342-9.
11. Tol J van Gulik T Busch O Gouma D. Centralisation of highly complex low-volume procedures in upper gastrointestinal surgery. A summary of systematic reviews and metaanalyses. Dig Surg.2012;29(5):374-83.
12. Parikh P Shiloach M Cohen M Bilimoria K Ko C Hall B et al. Pancreatectomy risk calculator: an ACS-N SQ1P resource. HPB. 2010; 12(7):488-97.
13. Kimura W Miyata H Gotoh M Hirai 1 Kenjo A Kitagawa Y et al. A Pancreaticoduodenectomy Risk Model Derived From 8575 Cases From a National Single-Race Population (Japanese) Using a Web-Based Data Entry System: The 30-Day and In-hospital Mortality Rates for Pancreaticoduodenectomy. Ann Surg. 2013; doi:
13. Kimura W, Miyata H, Gotoh M, Hirai 1, Kenjo A, Kitagawa Y, et al. A Pancreaticoduodenectomy Risk Model Derived From 8575 Cases From a National Single-Race Population (Japanese) Using a Web-Based Data Entry System: The 30-Day and In-hospital Mortality Rates for Pancreaticoduodenectomy. Ann Surg. 2013; doi: 10.1097/SLA.0000000000000263. [PubMed PMID 24253151], )| false
14. Van Heek N Kuhlmann K Scholten R De Castro S Busch O van Gulik T et al. Hospital volume and mortality after pancreatic resection. A systematic review and an evaluation of intervention in the Netherlands. Ann Surg. 2005;242(2):781-90.
15. Teh S Diggs B Deveney C Sheppard B. Patient and hospital characteristics on the variance of perioperative outcomes for pancreatic resection in the United States. A plea for outcome-based and not volume-based referral guidelines. Arch Surg. 2009; 144(8):713-21.