HPB : the official journal of the International Hepato Pancreato Biliary Association · 2026
Assessing the interplay of operative volume at the hospital and surgeon level for pancreatic cancer.
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Patel Dhruv J, Cotler Joseph H, Palis Bryan, Yang Anthony D, Schmidt C M, Weigel Ronald J, Bilimoria Karl Y, Ellis Ryan J
Аннотация
BACKGROUND: The current retrospective study aimed to assess the interaction between surgeon-volume and hospital-volume on outcomes after pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC).
METHODS: Patients with PDAC undergoing PD from 2008 to 2023 were identified using the National Cancer Database. Operative volumes of ≥20 cases/year defined high-volume hospitals (HVH) and ≥12 cases/year defined high-volume surgeons (HVS). Those below those thresholds were low-volume surgeons (LVS) and low-volume hospitals (LVH). Multivariable logistic regression was used to assess associations between surgeon/hospital volume and outcomes, relative to HVS/HVH.
RESULTS: The inclusion cohort consisted of 50,519 patients treated by 3155 surgeons operating at 976 hospitals. 90-day mortality declined with increasing volume: LVS/LVH = 6.4%, HVS/LVH = 5.7%, LVS/HVH = 4.0%, HVS/HVH = 3.5% (p < 0.001). Patients undergoing surgery by HVS/LVH [Odds Ratio (OR): 1.58, 95% Confidence Interval (95%CI) (1.12, 2.24), p = 0.009] and LVS/LVH [OR: 1.59, 95%CI (1.24, 2.04), p < 0.001] had a higher adjusted likelihood of mortality. LVS/HVH was not associated with mortality compared with HVS/HVH. Both HVS/LVH [OR: 1.93, 95%CI (1.27, 2.92), p = 0.002] and LVS/LVH [OR: 1.60, 95% CI (1.15, 2.23), p = 0.006] had a higher likelihood of readmission.
CONCLUSION: Outcomes after PD for PDAC remain more greatly influenced by hospital-volume rather than surgeon-volume.
METHODS: Patients with PDAC undergoing PD from 2008 to 2023 were identified using the National Cancer Database. Operative volumes of ≥20 cases/year defined high-volume hospitals (HVH) and ≥12 cases/year defined high-volume surgeons (HVS). Those below those thresholds were low-volume surgeons (LVS) and low-volume hospitals (LVH). Multivariable logistic regression was used to assess associations between surgeon/hospital volume and outcomes, relative to HVS/HVH.
RESULTS: The inclusion cohort consisted of 50,519 patients treated by 3155 surgeons operating at 976 hospitals. 90-day mortality declined with increasing volume: LVS/LVH = 6.4%, HVS/LVH = 5.7%, LVS/HVH = 4.0%, HVS/HVH = 3.5% (p < 0.001). Patients undergoing surgery by HVS/LVH [Odds Ratio (OR): 1.58, 95% Confidence Interval (95%CI) (1.12, 2.24), p = 0.009] and LVS/LVH [OR: 1.59, 95%CI (1.24, 2.04), p < 0.001] had a higher adjusted likelihood of mortality. LVS/HVH was not associated with mortality compared with HVS/HVH. Both HVS/LVH [OR: 1.93, 95%CI (1.27, 2.92), p = 0.002] and LVS/LVH [OR: 1.60, 95% CI (1.15, 2.23), p = 0.006] had a higher likelihood of readmission.
CONCLUSION: Outcomes after PD for PDAC remain more greatly influenced by hospital-volume rather than surgeon-volume.