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01-08-2015 | Healthcare Policy and Outcomes

Pancreatic Resection Results in a Statewide Surgical Collaborative

Authors: Mark A. Healy, MD, Robert W. Krell, MD, Zaid M. Abdelsattar, MD, Laurence E. McCahill, MD, David Kwon, MD, Timothy L. Frankel, MD, Samantha Hendren, MD, MPH, Darrell A. Campbell Jr., MD, Sandra L. Wong, MD, MS

Published in: Annals of Surgical Oncology | Issue 8/2015

Abstract

Background

A strong relationship between hospital caseload and adverse outcomes has been demonstrated for pancreatic resections. Participation in regional surgical collaboratives may mitigate this phenomenon. This study sought to investigate changes over time in adverse outcomes after pancreatectomy across hospitals with different caseloads in a statewide surgical collaborative.

Methods

The study investigated patients undergoing pancreatic resection from January 2008 to August 2013 at Michigan Surgical Quality Collaborative (MSQC) hospitals (1007 patients in 19 academic and community hospitals). Risk-adjusted rates of major complications, mortality, and failure to rescue were compared between hospitals based on caseloads (low, medium, and high) in early (2008–2010) and later (2011–2013) periods. Finally, the degree to which different complications explained changes in hospital outcome variation was assessed.

Results

Adjusted rates of major complications and mortality decreased over time, driven largely by improvements at low-caseload hospitals. In 2008–2010, risk-adjusted major complication rates were higher for low-caseload than for high-caseload hospitals (27.8 vs. 17.8 %; p = 0.02). However, these differences were attenuated in 2011–2013 (22.2 vs. 20.0 %; p = 0.74). Similarly, adjusted mortality rates were higher in low-caseload hospitals in 2008–2010 (6.2 vs. 0.8 %; p = 0.02), but these differences were attenuated in 2011–2013 (3.3 vs. 1.1 %; p = 0.18). Variation in major complications decreased, largely due to decreased variation in “medical” complication rates, with less change in surgical-site complications.

Conclusion

Participation in regional quality collaboratives by lower-volume hospitals can attenuate the volume–outcome relationship for pancreatic surgery. Continued work in collaboratives with an emphasis on technical and intraoperative aspects of care may improve overall quality of care.

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Title: Pancreatic Resection Results in a Statewide Surgical Collaborative
Authors: Mark A. Healy, MD
Robert W. Krell, MD
Zaid M. Abdelsattar, MD
Laurence E. McCahill, MD
David Kwon, MD
Timothy L. Frankel, MD
Samantha Hendren, MD, MPH
Darrell A. Campbell Jr., MD
Sandra L. Wong, MD, MS
Publication date: 01-08-2015
Publisher: Springer US
Published in: Annals of Surgical Oncology / Issue 8/2015
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-015-4529-9

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Pancreatic Resection Results in a Statewide Surgical Collaborative

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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