Journal of the American College of Surgeons · 2026
Disparity in Access to High-Volume Facilities for Pancreatic Surgery: Intersection of Race, Socioeconomics, and Geography.
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Brown Noah S, Horns Joshua J, Scaife Courtney L
Аннотация
BACKGROUND: Pancreaticoduodenectomy or total pancreatectomy for cancers involving the pancreatic head is a complex, high-risk operation. Although studies show improved survival at high-volume centers, many cases are still performed at low-volume centers (fewer than 10 cases per year). We aimed to examine whether patient factors, including racial, geographic, and socioeconomic disparities, influence the choice of center.
STUDY DESIGN: We analyzed 63,385 patients in the National Cancer Database who underwent pancreaticoduodenectomy or total pancreatectomy between 2011 and 2021. High-volume centers were defined as performing 10 cases or more annually. We performed univariate analysis and a Cox proportional hazards model adjusting for histology, stage, neoadjuvant treatment, Charlson-Deyo Score, race, ethnicity, insurance, income, and community status, with overall survival as the primary outcome.
RESULTS: At low-volume centers, 24.83% of cases were performed. The hazard ratio for survival at high-volume centers was 0.805 compared with low-volume centers (SE 0.011, p < 0.001). Median survival was significantly longer at high-volume centers (33.0 months, 95% CI 32.53 to 33.61) compared with low-volume centers (24.7 months, 95% CI 24.05 to 25.43). Black and Hispanic patients were more often treated at low-volume centers. Socioeconomically disadvantaged patients were also more likely to be treated at low-volume centers. Mortality rates were higher at low-volume centers (30-day mortality: 5.12% vs 2.38%, p < 0.001; 90-day mortality: 9.33% vs 5.16%, p < 0.001). Patients at low-volume centers lived closer to their centers (26.57 vs 69.93 miles, p < 0.001).
CONCLUSIONS: Disadvantaged patients are more likely to receive care at low-volume centers, where they experience poorer outcomes. Significant investment is needed to improve access to high-volume centers and address these disparities.
STUDY DESIGN: We analyzed 63,385 patients in the National Cancer Database who underwent pancreaticoduodenectomy or total pancreatectomy between 2011 and 2021. High-volume centers were defined as performing 10 cases or more annually. We performed univariate analysis and a Cox proportional hazards model adjusting for histology, stage, neoadjuvant treatment, Charlson-Deyo Score, race, ethnicity, insurance, income, and community status, with overall survival as the primary outcome.
RESULTS: At low-volume centers, 24.83% of cases were performed. The hazard ratio for survival at high-volume centers was 0.805 compared with low-volume centers (SE 0.011, p < 0.001). Median survival was significantly longer at high-volume centers (33.0 months, 95% CI 32.53 to 33.61) compared with low-volume centers (24.7 months, 95% CI 24.05 to 25.43). Black and Hispanic patients were more often treated at low-volume centers. Socioeconomically disadvantaged patients were also more likely to be treated at low-volume centers. Mortality rates were higher at low-volume centers (30-day mortality: 5.12% vs 2.38%, p < 0.001; 90-day mortality: 9.33% vs 5.16%, p < 0.001). Patients at low-volume centers lived closer to their centers (26.57 vs 69.93 miles, p < 0.001).
CONCLUSIONS: Disadvantaged patients are more likely to receive care at low-volume centers, where they experience poorer outcomes. Significant investment is needed to improve access to high-volume centers and address these disparities.