Pancreatico-Duodenectomy With High Quality Results in a Medium Volume Centre. What Are the Australian Definitions of Low Volume (#147)
The objective of this analysis was to determine whether it is possible to deliver pancreatico-duodenectomy at global standards in a regional city and attempt to define the minimum acceptable number of procedures annually compatible with providing such a service.
Methods. A ten year retrospective audit of prospectively maintained data from the period of October 2002 to October 2012 was undertaken in the 1 public and 2 private hospitals in Newcastle Australia where all the PDs for a regional population of 840000 were performed.
Results. 123 pancreatico-duodenectomies were performed in this period. The mean number of operations performed each year in all hospitals combined was 12.3. The number of operations per surgeon annually ranged from 0.2 per year to 5.8.
83.7% of patients suffered no significant complications, 30 day mortality was 4.1%. Significant differences were found between surgeon’s total significant complication rates: 8.6% to 50%. 30 day mortality: 0% to 50%. 3 surgeons performed >3 operations per year. These were all designated medium volume surgeons and they performed 91% of all PDs (112/123). The 3 other surgeons performed 9% (11/123) and were designated low volume surgeons. One hospital performed only 4 PDs and was designated a very low volume hospital. When the data from medium volume surgeons and medium volume hospitals was compared with the data from low volume surgeons and hospitals there was a significant difference in overall complication rates and mortality. Exclusion of the low volume surgeons and institutions was associated with a 1.9% 30 day mortality, a 12% significant morbidity and a 31% actuarial 5 year survival for periampullary malignancy.
Conclusion. There are both surgeon and hospital volume effects on outcome after PD. We have demonstrated that specialised Upper GI/HPB surgeons performing >3 PDs per annum can achieve results in a medium volume centre equivalent to those achieved in high volume centres around the world.
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