Assessing the interplay of operative volume at the hospital and surgeon level for pancreatic cancer

IF 3.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2026-10-01 Epub Date: 2026-07-21 DOI:10.1016/j.hpb.2026.07.007

Dhruv J. Patel, Joseph H. Cotler, Bryan Palis, Anthony D. Yang, C.M. Schmidt, Ronald J. Weigel, Karl Y. Bilimoria, Ryan J. Ellis

{"title":"Assessing the interplay of operative volume at the hospital and surgeon level for pancreatic cancer","authors":"Dhruv J. Patel, Joseph H. Cotler, Bryan Palis, Anthony D. Yang, C.M. Schmidt, Ronald J. Weigel, Karl Y. Bilimoria, Ryan J. Ellis","doi":"10.1016/j.hpb.2026.07.007","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><div>The current retrospective study aimed to assess the interaction between surgeon-volume and hospital-volume on outcomes after pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC).</div></div><div><h3>Methods</h3><div>Patients with PDAC undergoing PD from 2008 to 2023 were identified using the National Cancer Database. Operative volumes of ≥20 cases/year defined high-volume hospitals (HVH) and ≥12 cases/year defined high-volume surgeons (HVS). Those below those thresholds were low-volume surgeons (LVS) and low-volume hospitals (LVH). Multivariable logistic regression was used to assess associations between surgeon/hospital volume and outcomes, relative to HVS/HVH.</div></div><div><h3>Results</h3><div>The inclusion cohort consisted of 50,519 patients treated by 3155 surgeons operating at 976 hospitals. 90-day mortality declined with increasing volume: LVS/LVH = 6.4%, HVS/LVH = 5.7%, LVS/HVH = 4.0%, HVS/HVH = 3.5% (p < 0.001). Patients undergoing surgery by HVS/LVH [Odds Ratio (OR): 1.58, 95% Confidence Interval (95%CI) (1.12, 2.24), p = 0.009] and LVS/LVH [OR: 1.59, 95%CI (1.24, 2.04), p < 0.001] had a higher adjusted likelihood of mortality. LVS/HVH was not associated with mortality compared with HVS/HVH. Both HVS/LVH [OR: 1.93, 95%CI (1.27, 2.92), p = 0.002] and LVS/LVH [OR: 1.60, 95% CI (1.15, 2.23), p = 0.006] had a higher likelihood of readmission.</div></div><div><h3>Conclusion</h3><div>Outcomes after PD for PDAC remain more greatly influenced by hospital-volume rather than surgeon-volume.</div></div>","PeriodicalId":13229,"journal":{"name":"Hpb","volume":"28 10","pages":"Pages 1402-1412"},"PeriodicalIF":3.3000,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Hpb","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S1365182X2600701X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2026/7/21 0:00:00","PubModel":"Epub","JCR":"Q2","JCRName":"GASTROENTEROLOGY & HEPATOLOGY","Score":null,"Total":0}

引用次数: 0

Abstract

Background

The current retrospective study aimed to assess the interaction between surgeon-volume and hospital-volume on outcomes after pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC).

Methods

Patients with PDAC undergoing PD from 2008 to 2023 were identified using the National Cancer Database. Operative volumes of ≥20 cases/year defined high-volume hospitals (HVH) and ≥12 cases/year defined high-volume surgeons (HVS). Those below those thresholds were low-volume surgeons (LVS) and low-volume hospitals (LVH). Multivariable logistic regression was used to assess associations between surgeon/hospital volume and outcomes, relative to HVS/HVH.

Results

The inclusion cohort consisted of 50,519 patients treated by 3155 surgeons operating at 976 hospitals. 90-day mortality declined with increasing volume: LVS/LVH = 6.4%, HVS/LVH = 5.7%, LVS/HVH = 4.0%, HVS/HVH = 3.5% (p < 0.001). Patients undergoing surgery by HVS/LVH [Odds Ratio (OR): 1.58, 95% Confidence Interval (95%CI) (1.12, 2.24), p = 0.009] and LVS/LVH [OR: 1.59, 95%CI (1.24, 2.04), p < 0.001] had a higher adjusted likelihood of mortality. LVS/HVH was not associated with mortality compared with HVS/HVH. Both HVS/LVH [OR: 1.93, 95%CI (1.27, 2.92), p = 0.002] and LVS/LVH [OR: 1.60, 95% CI (1.15, 2.23), p = 0.006] had a higher likelihood of readmission.

Conclusion

Outcomes after PD for PDAC remain more greatly influenced by hospital-volume rather than surgeon-volume.

查看原文本刊更多论文

评估胰腺癌医院和外科手术量的相互作用。

背景：本回顾性研究旨在评估手术量和住院量对胰十二指肠切除术（PD）治疗胰导管腺癌（PDAC）后预后的相互作用。方法：使用国家癌症数据库对2008年至2023年接受PD治疗的PDAC患者进行鉴定。手术量≥20例/年定义大容量医院（HVH）和≥12例/年定义大容量外科医生（HVS）。低于这些阈值的是小容量外科医生（LVS）和小容量医院（LVH）。多变量逻辑回归用于评估外科医生/医院数量与HVS/HVH预后之间的关联。结果：纳入队列包括976家医院3155名外科医生治疗的50,519例患者。90天死亡率随容积增加而下降：LVS/LVH = 6.4%, HVS/LVH = 5.7%, LVS/HVH = 4.0%, HVS/HVH = 3.5% （p < 0.001）。接受HVS/LVH手术的患者[优势比（OR）： 1.58, 95%可信区间（95% ci）（1.12, 2.24）， p = 0.009]和LVS/LVH [OR: 1.59, 95% ci (1.24, 2.04), p < 0.001]具有更高的校正死亡率。与HVS/HVH相比，LVS/HVH与死亡率无关。HVS/LVH [OR: 1.93, 95%CI (1.27, 2.92), p = 0.002]和LVS/LVH [OR: 1.60, 95%CI (1.15, 2.23), p = 0.006]再入院的可能性较高。结论：PDAC患者PD后的预后受医院数量的影响大于手术数量的影响。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

求助全文

约1分钟内获得全文求助全文

来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).