Practice composition and sub-specialization among fellowship-trained HPB surgeons: impact on outcomes following hepatopancreatic surgery.

IF 3.3 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2026-08-20 DOI:10.1016/j.hpb.2026.08.009

Diamantis I Tsilimigras, Selamawit Woldesenbet, Odysseas P Chatzipanagiotou, Timothy M Pawlik

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引用次数: 0

Abstract

Introduction: The impact of sub-specialization and practice composition among surgeons performing hepatopancreatic (HP) surgery in the United States has not been previously characterized.

Methods: Medicare beneficiaries undergoing HP surgery (2016-2021) were identified. HP practice composition, defined as the proportion of HP procedures among all surgeries performed by each surgeon during the study period was assessed. The primary outcome was achievement of textbook outcome (TO) after HP surgery relative to HP practice composition.

Results: A total of 20,614 HP procedures were performed by 710 fellowship-trained surgeons (CGSO:n = 578, 81.4%, AHPBA:n = 111, 15.6%, both n = 21, 3.0%). Most surgeons were low-volume for both hepatic and pancreatic surgery (H-low/P-low:41.1%). CGSO and AHPBA fellowship graduates had comparable liver and pancreas volume practices (p = 0.24). Median HP practice composition among all surgeons was 20.7% (IQR:10.1-35.7%). Higher HP-specific volume and higher HP practice composition were independently associated with a greater probability of TO after hepatectomy and pancreatectomy (both p < 0.05). Among CGSO graduates, HP practice composition varied significantly by graduating CGSO program.

Conclusions: HP case composition varied markedly relative to fellowship training. Despite greater HP case composition being associated with improved outcomes, most fellowship-trained HP surgeons maintained broad-based and low volume HP practices.

查看原文本刊更多论文

在接受过奖学金培训的HPB外科医生中，实践组成和亚专业化：对肝胰手术后结果的影响。

在美国，外科医生进行肝胰脏（HP）手术的亚专业化和实践组成的影响以前没有被描述过。方法：确定2016-2021年接受HP手术的医疗保险受益人。评估HP操作构成，定义为每位外科医生在研究期间进行的所有手术中HP操作的比例。主要结局是HP手术后相对于HP实践组成的教科书结局（TO）的实现。结果：710名接受奖学金培训的外科医生共实施了20,614例HP手术（CGSO:n = 578, 81.4%, AHPBA:n = 111, 15.6%，均为n = 21,3.0%）。大多数肝脏和胰腺手术的外科医生都是低容积的（H-low/P-low:41.1%）。CGSO和AHPBA奖学金毕业生的肝脏和胰腺体积比较（p = 0.24）。所有外科医生的HP执业构成中位数为20.7% （IQR:10.1-35.7%）。较高的HP特异性体积和较高的HP实践组成与肝切除术和胰腺切除术后更高的TO概率独立相关（p < 0.05）。在CGSO毕业生中，HP实践构成因CGSO项目的不同而有显著差异。结论：与研究员培训相关，HP病例构成显著不同。尽管更大的HP病例构成与改善的预后相关，但大多数接受过奖学金培训的HP外科医生仍保持广泛和小剂量的HP手术。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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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).