Observational Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2016; 8(8): 583-589
Published online Aug 27, 2016. doi: 10.4240/wjgs.v8.i8.583
Pancreaticoduodenectomy: A study from India on the impact of evolution from a low to a high volume unit
Omar J Shah, Manmohan Singh, Mohammad R Lattoo, Sadaf A Bangri
Omar J Shah, Manmohan Singh, Mohammad R Lattoo, Sadaf A Bangri, Department of Surgical Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190011, India
Author contributions: Shah OJ and Singh M designed and conceptualized the study; Shah OJ, Singh M and Bangri SA performed the study; Shah OJ and Lattoo MR analysed the data; Shah OJ and Singh M wrote the paper.
Institutional review board statement: The study was approved by the SKIMS institutional review board.
Conflict-of-interest statement: There are no conflicts of interest to report.
Data sharing statement: Consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Omar J Shah, Professor, Department of Surgical Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Soura, Srinagar, Jammu, Kashmir 190011, India. omarjshah@yahoo.com
Telephone: +91-194-2463774 Fax: +91-194-2403470
Received: March 5, 2016
Peer-review started: March 7, 2016
First decision: April 11, 2016
Revised: April 20, 2016
Accepted: May 17, 2016
Article in press: May 27, 2016
Published online: August 27, 2016
Processing time: 174 Days and 11.8 Hours
Abstract
AIM

To analyse the impact of turning of our department from a low to a high volume provider of pancreaticoduodenectomy (PD) on surgical outcome.

METHODS

A retrospective collection of data was done for patients who underwent PD. According to the number of PDs undertaken per year, we categorized the volume into low volume (< 10 PDs/year), medium volume (10-24 PDs/year) and high volume (> 25 PDs/year) groups.

RESULTS

From 2002 to 2013, 200 patients underwent PD. The annual number of PD increased from 4 in 2002 to 34 in 2013. The mean operative time, operative blood loss and need for intraoperative blood transfusion decreased considerably over the volume categories (P < 0.001, P < 0.001 and P < 0.001, respectively). Increased procedural volume was associated with a lower morbidity (P = 0.021) and shorter length of hospital stay (P < 0.001). Similarly the rate of mortality dropped from 10% for the low volume group to 2.2% for the medium volume group and 0.0% for the high volume group (P = 0.007).

CONCLUSION

The transformation from a low volume to a high volume provider of PD resulted in most favourable outcomes favouring the continued centralization of this high risk procedure.

Keywords: Pancreaticoduodenectomy; High volume centre

Core tip: Due to the complexity and challenging nature of pancreaticoduodenectomy, it is likely that both short- and long-term outcomes strongly depend on the cumulative number of cases performed by the surgeon as well as by the hospital. Strong evidence exists for volume-outcome relationship in which high volume centres have reduced perioperative morbidity and mortality. High volume hospitals are assumed to have structural characteristics associated with better quality of care, and providers in these hospitals are thought to improve their processes of care through experience in providing complex care. While the findings of this study are presented in terms of high, medium, and low volume periods, an important point exists regarding the volume-outcome relationship that must be emphasized. Thus for patients seeking to identify a hospital at which to have their surgery, the best strategy if all other factors are equal is to choose the hospital that performs pancreatic surgery most frequently.