Patient and hospital characteristics on the variance of perioperative outcomes for pancreatic resection in the United States: A plea for outcome-based and not volume-based referral guidelines

Swee H. Teh, Brian S. Diggs, Clifford Deveney, Brett Sheppard

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Abstract

Hypothesis: There is an effect of patient and hospital characteristics on perioperative outcomes for pancreatic resection in the United States. Design: Retrospective cohort study. Setting: Academic research. Patients: Patient data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project from January 1988 to January 2003. Main Outcome Measures: In-hospital mortality, perioperative complications, and mortality following a major complication. Results: A total of 103 222 patients underwent major pancreatic surgery. The annual number of pancreatic resections increased 15.0% during the 16-year study period. Resection for benign pancreatic disease increased 26.8%. Overall in-hospital mortality, perioperative complications, and mortality following a major complication were 6.5%, 35.6%, and 15.6%, respectively. Multivariate analysis demonstrated that significant independent predictors for these 3 perioperative outcomes were advancing age, male sex, medical comorbidity, and hospital volume for each type of pancreatic resection. The inhospital mortality for pancreatoduodenectomy increases with age and ranges from 1.7% to 13.8% (P

Original languageEnglish (US)
Pages (from-to)713-721
Number of pages9
JournalArchives of Surgery
Volume144
Issue number8
DOIs
StatePublished - Aug 2009

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Referral and Consultation
Hospital Mortality
Guidelines
Pancreatic Diseases
Pancreaticoduodenectomy
Mortality
Health Care Costs
Comorbidity
Inpatients
Cohort Studies
Multivariate Analysis
Retrospective Studies
Outcome Assessment (Health Care)
Research

ASJC Scopus subject areas

  • Surgery

Cite this

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title = "Patient and hospital characteristics on the variance of perioperative outcomes for pancreatic resection in the United States: A plea for outcome-based and not volume-based referral guidelines",
abstract = "Hypothesis: There is an effect of patient and hospital characteristics on perioperative outcomes for pancreatic resection in the United States. Design: Retrospective cohort study. Setting: Academic research. Patients: Patient data from the Nationwide Inpatient Sample of the Healthcare Cost and Utilization Project from January 1988 to January 2003. Main Outcome Measures: In-hospital mortality, perioperative complications, and mortality following a major complication. Results: A total of 103 222 patients underwent major pancreatic surgery. The annual number of pancreatic resections increased 15.0{\%} during the 16-year study period. Resection for benign pancreatic disease increased 26.8{\%}. Overall in-hospital mortality, perioperative complications, and mortality following a major complication were 6.5{\%}, 35.6{\%}, and 15.6{\%}, respectively. Multivariate analysis demonstrated that significant independent predictors for these 3 perioperative outcomes were advancing age, male sex, medical comorbidity, and hospital volume for each type of pancreatic resection. The inhospital mortality for pancreatoduodenectomy increases with age and ranges from 1.7{\%} to 13.8{\%} (P",
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AU - Sheppard, Brett

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