Ninety day mortality following pancreatoduodenectomy in England: has the optimum centre volume been identified?

Liu, Z and Peneva, I S and Evison, Felicity and Sahdra, S and Mirza, D F and Charnley, R M and Savage, R and Moss, P A and Roberts, K J (2018) Ninety day mortality following pancreatoduodenectomy in England: has the optimum centre volume been identified? HPB : the official journal of the International Hepato Pancreato Biliary Association, 20 (11). pp. 1012-1020. ISSN 1477-2574. This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs.

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Official URL: https://www.hpbonline.org/article/S1365-182X(18)30...

Abstract

BACKGROUND

Mortality following pancreatoduodenectomy is related to centre volume although the optimal volume is not defined.

METHODS

Patients undergoing PD between 2001 and 2016 were identified from UK national databases. The effects of patient variables, centre volume and time period upon 90 day mortality were studied.

RESULTS

90 day mortality (970/14,935, 6.5%) was related to advanced age, comorbidity, diagnosis, ethnicity, deprivation, centre volume and time period. Mortality rates fell markedly from 10.0% in 2001-4 to 4.1% in 2013-16. There was no difference in 90 day mortality between high (36 -60 PD per year) and very high volume (>60) centres. However, patients operated upon at very high volume centres were more elderly (66, 58 -73 vs 65, 56 -72; median, IQR; p = 0.006), deprived (38.7 vs 34.6%; p < 0.001) and co morbid (48.9 vs 46.1%; p = 0.027).

CONCLUSION

Although a plateau in the centre volume and mortality relationship appears to have been demonstrated those patients treated at the highest volume centres were at higher risk of mortality. This data suggests therefore that to further understand outcomes from specialist centres characteristics of the patient population should be defined, not just centre volume.

Item Type: Article
Additional Information: This article is available to all UHB staff and students via ASK Discovery tool http://tinyurl.com/z795c8c by using their UHB Athens login IDs.
Subjects: WH Haemic and lymphatic systems. Haematology
WO Surgery
Divisions: Clinical Support
Planned IP Care > General Surgery
Planned IP Care > Oncology and Clinical Haematology
Related URLs:
Depositing User: Mrs Noomi Tyholdt-Pidgley
Date Deposited: 11 Dec 2019 09:40
Last Modified: 11 Dec 2019 09:40
URI: http://www.repository.uhblibrary.co.uk/id/eprint/2675

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