Volume-cost relationship in Pancreatic Surgery: A scoping review

Objectives

To synthesize evidence on the volume-cost relationship (VCR) in pancreatic surgery, focusing on the impact of hospital and surgeon volumes on economic indicators.

Methods

A scoping review was conducted using PubMed, Web of Science, and Scopus to identify studies published from inception to November 30, 2024, to ensure a comprehensive and unbiased review of all relevant studies. The PRISMA-ScR framework guided data extraction, focusing on hospital and surgeon volumes in relation to costs, length of stay (LOS), resource utilization, and readmissions. The metrics included cost definitions, volume thresholds, and economic indicators. Studies that analyzed the economic impact of centralization in pancreatic surgery were included.

Results

Twenty-two studies (1996–2024), primarily from the United States, were included. Pancreaticoduodenectomy was the most studied procedure. High-volume Hospitals (HVHs) consistently demonstrated reduced costs, shorter LOS, lower resource utilization, and higher discharge-to-home rates compared to low-volume hospitals (LVHs). Cost reductions were attributed to enhanced efficiency and fewer complications. However, there was significant variability in volume thresholds and limited use of cost-effectiveness analyses (CEAs). Few studies addressed broader societal costs, such as productivity losses or caregiver burden.

Conclusions

Centralizing pancreatic surgeries in HVHs offers clear economic impact through improved efficiency and outcomes. Addressing gaps in standardized volume definitions, incorporating socioeconomic factors, and expanding CEAs are critical for optimizing resource allocation and ensuring equitable and cost-effective care. Future research should focus on these areas to inform better health policies.