In-hospital Mortality Following Pancreatoduodenectomy: a Comprehensive Analysis.
Mortality
Pancreas
Pancreatoduodenectomy
Volume
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
05 2020
05 2020
Historique:
received:
15
04
2019
accepted:
11
06
2019
pubmed:
12
7
2019
medline:
15
4
2021
entrez:
12
7
2019
Statut:
ppublish
Résumé
While patient- and hospital-level factors affecting outcomes of patients undergoing pancreatoduodenectomy (PD) have been well described separately, the relative impact of these factors on in-hospital mortality has not been comprehensively assessed. Retrospective review of the National Inpatient Sample database (January 2004-December 2014) was conducted to identify patients undergoing PD. Factors associated with in-hospital mortality after PD were analyzed after adjusting for previously defined patient- and hospital-level risk factors. A total of 9639 patients who underwent a PD at 2325 hospitals were identified. Median patient age was 57 years (IQR 66-73). Overall, mortality following PD was 3.2%. When patient- and hospital-level characteristics were analyzed in the same model, patient-level characteristic associated with increased odds of in-hospital mortality included increasing patient age (OR 1.05, 95% CI 1.03-1.06/per 5 years increase), male sex (OR 1.47, 95% CI 1.16-1.86), the presence of liver disease (OR 3.03, 95% CI 1.99-4.61), chronic kidney disease (OR 1.78, 95% CI 1.18-2.68), and congestive heart failure (OR 2.48, 95% CI 1.65-3.74). The only hospital characteristic associated with odds of mortality following PD included compliance with Leapfrog volume standards (OR 0.70, 95% CI 0.54-0.92). Patient-level factors, such as advanced comorbidities, male sex, and increased age, contributed the most to increased risk of mortality after PD. Hospital volume was the only hospital-level factor contributing to risk of in-hospital mortality following PD.
Sections du résumé
BACKGROUND
While patient- and hospital-level factors affecting outcomes of patients undergoing pancreatoduodenectomy (PD) have been well described separately, the relative impact of these factors on in-hospital mortality has not been comprehensively assessed.
METHODS
Retrospective review of the National Inpatient Sample database (January 2004-December 2014) was conducted to identify patients undergoing PD. Factors associated with in-hospital mortality after PD were analyzed after adjusting for previously defined patient- and hospital-level risk factors.
RESULTS
A total of 9639 patients who underwent a PD at 2325 hospitals were identified. Median patient age was 57 years (IQR 66-73). Overall, mortality following PD was 3.2%. When patient- and hospital-level characteristics were analyzed in the same model, patient-level characteristic associated with increased odds of in-hospital mortality included increasing patient age (OR 1.05, 95% CI 1.03-1.06/per 5 years increase), male sex (OR 1.47, 95% CI 1.16-1.86), the presence of liver disease (OR 3.03, 95% CI 1.99-4.61), chronic kidney disease (OR 1.78, 95% CI 1.18-2.68), and congestive heart failure (OR 2.48, 95% CI 1.65-3.74). The only hospital characteristic associated with odds of mortality following PD included compliance with Leapfrog volume standards (OR 0.70, 95% CI 0.54-0.92).
CONCLUSION
Patient-level factors, such as advanced comorbidities, male sex, and increased age, contributed the most to increased risk of mortality after PD. Hospital volume was the only hospital-level factor contributing to risk of in-hospital mortality following PD.
Identifiants
pubmed: 31292889
doi: 10.1007/s11605-019-04307-9
pii: 10.1007/s11605-019-04307-9
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1119-1126Références
Fernández-del Castillo C, Morales-Oyarvide V, McGrath D, et al. Evolution of the Whipple procedure at the Massachusetts General Hospital. Surgery. 2012;152(3 Suppl 1):S56–63.
doi: 10.1016/j.surg.2012.05.022
Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346(15):1128–1137.
doi: 10.1056/NEJMsa012337
Ghaferi AA, Osborne NH, Birkmeyer JD, Dimick JB. Hospital characteristics associated with failure to rescue from complications after pancreatectomy. J Am Coll Surg. 2010;211(3):325–330.
doi: 10.1016/j.jamcollsurg.2010.04.025
Nathan H, Cameron JL, Choti MA, Schulick RD, Pawlik TM. The volume-outcomes effect in hepato-pancreato-biliary surgery: hospital versus surgeon contributions and specificity of the relationship. J Am Coll Surg. 2009;208(4):528–538.
doi: 10.1016/j.jamcollsurg.2009.01.007
Hyder O, Dodson RM, Nathan H, et al. Influence of patient, physician, and hospital factors on 30-day readmission following pancreatoduodenectomy in the United States. JAMA Surg. 2013;148(12):1095–1102.
doi: 10.1001/jamasurg.2013.2509
Sosa JA, Bowman HM, Gordon TA, et al. Importance of hospital volume in the overall management of pancreatic cancer. Ann Surg. 1998;228(3):429–438.
doi: 10.1097/00000658-199809000-00016
Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA. 2000;283(9):1159–1166.
doi: 10.1001/jama.283.9.1159
Gordon TA, Bowman HM, Tielsch JM, Bass EB, Burleyson GP, Cameron JL. Statewide regionalization of pancreaticoduodenectomy and its effect on in-hospital mortality. Ann Surg. 1998;228(1):71–78.
doi: 10.1097/00000658-199807000-00011
Cameron JL, He J. Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg. 2015;220(4):530–536.
doi: 10.1016/j.jamcollsurg.2014.12.031
Carroll JE, Smith JK, Simons JP, et al. Redefining mortality after pancreatic cancer resection. J Gastrointest Surg. 2010;14(11):1701–1708.
doi: 10.1007/s11605-010-1326-4
Finks JF, Osborne NH, Birkmeyer JD. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med. 2011;364(22):2128–2137.
doi: 10.1056/NEJMsa1010705
Nimptsch U, Krautz C, Weber GF, Mansky T, Grützmann R. Nationwide In-hospital Mortality Following Pancreatic Surgery in Germany is Higher than Anticipated. Ann Surg. 2016;264(6):1082–1090.
doi: 10.1097/SLA.0000000000001693
Varley PR, Geller DA, Tsung A. Factors influencing failure to rescue after pancreaticoduodenectomy: a National Surgical Quality Improvement Project Perspective. J Surg Res. 2017;214:131–139.
doi: 10.1016/j.jss.2016.09.005
Chen Q, Merath K, Bagante F, et al. A Comparison of Open and Minimally Invasive Surgery for Hepatic and Pancreatic Resections Among the Medicare Population. J Gastrointest Surg. 2018.
Hyder O, Sachs T, Ejaz A, Spolverato G, Pawlik TM. Impact of hospital teaching status on length of stay and mortality among patients undergoing complex hepatopancreaticobiliary surgery in the USA. J Gastrointest Surg. 2013;17(12):2114–2122.
doi: 10.1007/s11605-013-2349-4
Kneuertz PJ, Pitt HA, Bilimoria KY, et al. Risk of morbidity and mortality following hepato-pancreato-biliary surgery. J Gastrointest Surg. 2012;16(9):1727–1735.
doi: 10.1007/s11605-012-1938-y
Quality. AfHaR. HCUP NIS description of data elements.Healthcare cost and utilization project (HCUP). 2008; http://www.hcup-us.ahrq.gov/db/nation/nis/nisdde.jsp . Accessed January 15, 2019.
Leapfrog G. Hospital Safety Score: Scoring Methodology. 2012; http://www.hospitalsafetyscore.org/media/file/HospitalSafetyScore_ScoringMethodology_Fall2013_Updated.pdf . Accessed 11/28/2018.
Tamirisa NP, Parmar AD, Vargas GM, et al. Relative Contributions of Complications and Failure to Rescue on Mortality in Older Patients Undergoing Pancreatectomy. Ann Surg. 2016;263(2):385–391.
doi: 10.1097/SLA.0000000000001093
Hill JS, Zhou Z, Simons JP, et al. A simple risk score to predict in-hospital mortality after pancreatic resection for cancer. Ann Surg Oncol. 2010;17(7):1802–1807.
doi: 10.1245/s10434-010-0947-x
McPhee JT, Hill JS, Whalen GF, et al. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg. 2007;246(2):246–253.
doi: 10.1097/01.sla.0000259993.17350.3a
van Rijssen LB, Zwart MJ, van Dieren S, et al. Variation in hospital mortality after pancreatoduodenectomy is related to failure to rescue rather than major complications: a nationwide audit. HPB (Oxford). 2018;20(8):759–767.
doi: 10.1016/j.hpb.2018.02.640
Hughes TM, Merath K, Chen Q, et al. Association of shared decision-making on patient-reported health outcomes and healthcare utilization. Am J Surg. 2018;216(1):7–12.
doi: 10.1016/j.amjsurg.2018.01.011
Beger HG. Benign Tumors of the Pancreas-Radical Surgery Versus Parenchyma-Sparing Local Resection-the Challenge Facing Surgeons. J Gastrointest Surg. 2018;22(3):562–566.
doi: 10.1007/s11605-017-3644-2
Dimick JB, Cowan JA, Colletti LM, Upchurch GR. Hospital teaching status and outcomes of complex surgical procedures in the United States. Arch Surg. 2004;139(2):137–141.
doi: 10.1001/archsurg.139.2.137
Merath K, Chen Q, Bagante F, et al. Variation in the cost-of-rescue among medicare patients with complications following hepatopancreatic surgery. HPB (Oxford). 2018.
Delitto D, Black BS, Cunningham HB, et al. Standardization of surgical care in a high-volume center improves survival in resected pancreatic head cancer. Am J Surg. 2016;212(2):195–201.e191.
doi: 10.1016/j.amjsurg.2016.03.001
Hata T, Motoi F, Ishida M, et al. Effect of Hospital Volume on Surgical Outcomes After Pancreaticoduodenectomy: A Systematic Review and Meta-analysis. Ann Surg. 2016;263(4):664–672.
doi: 10.1097/SLA.0000000000001437
Krautz C, Nimptsch U, Weber GF, Mansky T, Grützmann R. Effect of Hospital Volume on In-hospital Morbidity and Mortality Following Pancreatic Surgery in Germany. Ann Surg. 2017.
Schmidt CM, Turrini O, Parikh P, et al. Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy: a single-institution experience. Arch Surg. 2010;145(7):634–640.
doi: 10.1001/archsurg.2010.118
Adam MA, Choudhury K, Dinan MA, et al. Minimally Invasive Versus Open Pancreaticoduodenectomy for Cancer: Practice Patterns and Short-term Outcomes Among 7061 Patients. Ann Surg. 2015;262(2):372–377.
doi: 10.1097/SLA.0000000000001055
Lieberman MD, Kilburn H, Lindsey M, Brennan MF. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann Surg. 1995;222(5):638–645.
doi: 10.1097/00000658-199511000-00006
Gouma DJ, van Geenen RC, van Gulik TM, et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg. 2000;232(6):786–795.
doi: 10.1097/00000658-200012000-00007
Alsfasser G, Leicht H, Günster C, Rau BM, Schillinger G, Klar E. Volume-outcome relationship in pancreatic surgery. Br J Surg. 2016;103(1):136–143.
doi: 10.1002/bjs.9958
Ho V, Heslin MJ. Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann Surg. 2003;237(4):509–514.
pubmed: 12677147
pmcid: 1514467
Leapfrog. Leapfrog group Volume Standards. http://www.leapfroggroup.org/sites/default/files/Files/LeapfrogHospitalSurvey_ProposedChanges_2019_Final.pdf . Accessed January 15, 2019.
Birkmeyer JD, Dimick JB. Potential benefits of the new Leapfrog standards: effect of process and outcomes measures. Surgery. 2004;135(6):569–575.
doi: 10.1016/j.surg.2004.03.004
Nathan H, Pawlik TM. Limitations of claims and registry data in surgical oncology research. Ann Surg Oncol. 2008;15(2):415–423.
doi: 10.1245/s10434-007-9658-3