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Surgical Endoscopy

Published in:

01-07-2017

Presence of a fellowship improves perioperative outcomes following hepatopancreatobiliary procedures

Authors: Maria S. Altieri, Jie Yang, Donglei Yin, Catherine Frenkel, Mark Talamini, Dana A. Telem, Aurora Pryor

Published in: Surgical Endoscopy | Issue 7/2017

Abstract

Introduction

There is an increase in subspecialization and in the number of surgeons seeking fellowship training in the USA. Little is known regarding the effect of hepatopancreatobiliary (HPB) fellowship programs’ status of an institution on perioperative outcomes. This study aims to examine the effect of such status on perioperative outcomes across all institutions following complex surgeries involving HPB procedures in the State of New York (NYS).

Methods

The Statewide Planning and Research Cooperative System administrative database was used to identify several complex surgeries involving the pancreas, liver, and gallbladder by using ICD-9 codes for inpatient procedures between 2012 and 2014. Procedures were compared in terms of 30-day readmission, hospital length of stay (HLOS), and major complications between institutions with and without fellowship. Linear mixed model and generalized linear mixed models were used to compare the differences.

Results

There were 4156 procedures identified during 2012–2014 in NYS. Among these, 1685 (40.5%) were pancreatic surgeries only, 1031 (24.8%) were liver surgeries only, 1288 (31.0%) were gallbladder surgeries only, 11 (0.3%) were both pancreatic and liver surgeries, 124 (3.0%) were both liver and gallbladder, and 17 (0.4%) were both pancreatic and gallbladder. Elderly patients tended to go to the hospitals with HPB fellowship. Following multivariable regression and controlling for other factors, hospitals with fellowships remained significantly associated with less severe complications (OR 0.49, 95% CI 0.29–0.83, p = 0.0075). No significant differences were seen between hospitals with and without fellowship in terms of 30-day readmissions (p = 0.6) and HLOS (p = 0.4).

Conclusion

Institutions offering HPB fellowship training were associated with significantly improved rate of complications, although there was no significant difference in terms of 30-day readmission rate or HLOS. This data highlight the importance of a presence of a fellowship in complex hepatopancreatobiliary procedures.

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Title: Presence of a fellowship improves perioperative outcomes following hepatopancreatobiliary procedures
Authors: Maria S. Altieri
Jie Yang
Donglei Yin
Catherine Frenkel
Mark Talamini
Dana A. Telem
Aurora Pryor
Publication date: 01-07-2017
Publisher: Springer US
Published in: Surgical Endoscopy / Issue 7/2017
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI: https://doi.org/10.1007/s00464-016-5306-y

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Presence of a fellowship improves perioperative outcomes following hepatopancreatobiliary procedures

Abstract

Introduction

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Introduction

Methods

Results

Conclusion

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