ArticleHPB : the official journal of the International Hepato Pancreato Biliary Association2014
Patient selection and the volume effect in pancreatic surgery: unequal benefits?
Article in HPB : the official journal of the International Hepato Pancreato Biliary Association, 2014. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 2 of them syntheses that pooled it.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
18 citing papers in PubMed, 2 syntheses or guidelines pooled it, 52 citations in OpenAlex.
- Mortality factors in pancreatic surgery: A systematic review. How important is the hospital volume?International journal of surgery (London, England) · 2022Pooled it
- A Systematic Review of the Factors that Patients Use to Choose their Surgeon.World journal of surgery · 2016Pooled it
- Failure to Undergo Resection Following Neoadjuvant Therapy for Resectable Pancreatic Cancer: A Secondary Analysis of SWOG S1505.Journal of the National Comprehensive Cancer Network : JNCCN · 2024Trial
- Assessing the interplay of operative volume at the hospital and surgeon level for pancreatic cancer.HPB : the official journal of the International Hepato Pancreato Biliary Association · 2026Article
- Not Only Caseload but Also Patient Selection Is Predictive of Mortality After Pancreatic Resection.Annals of surgery open : perspectives of surgical history, education, and clinical approaches · 2025Article
- Review
- A Cross-Sectional Study on Patient Preferences for Selecting Surgeons for Joint Replacement Surgery in India.Cureus · 2024Article
- Rescue from complications after pancreaticoduodenectomies at a low-volume Caribbean center: Value of tailored peri-pancreatectomy protocols.World journal of gastrointestinal surgery · 2024Article
- Risk of Ischemic Heart Disease in Patients With Postpancreatectomy Diabetes and Pancreatic Cancer: A Population-Based Study.Journal of the American Heart Association · 2023Article
- Whipple's procedure for pancreatic cancer: training and the hospital environment are more important than volume alone.Surgery in practice and science · 2023Article
- Whipple's pancreaticoduodenectomy at a resource-poor, low-volume center in Trinidad and Tobago.World journal of clinical oncology · 2022Article
- Whipple's operation with a modified centralization concept: A model in low-volume Caribbean centers.World journal of clinical cases · 2022Review
- Review
- Impact of certification status of the institute and surgeon on short-term outcomes after surgery for thoracic esophageal cancer: evaluation using data on 16,752 patients from the National Clinical Database in Japan.Esophagus : official journal of the Japan Esophageal Society · 2020Article
- Article
- National trends in therapeutic approaches and outcomes for pediatric appendicitis: a Taiwanese nationwide cohort study.Pediatric surgery international · 2015Article
- Appendicitis in the modern era: universal problem and variable treatment.Surgical endoscopy · 2015Article
- Diabetes after pancreatic surgery: novel issues.Current diabetes reports · 2015Review
Corrections and comments
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Authors and funding
9 authors at 4 institutions in 1 country.
Funding
Abstract
backgroundThe volume effect in pancreatic surgery is well established. Regionalization to high-volume centres has been proposed. The effect of this proposal on practice patterns is unknown.
methodsRetrospective review of pancreatectomy patients in the Nationwide Inpatient Sample 2004-2011. Inpatient mortality and complication rates were calculated. Patients were stratified by annual centre pancreatic resection volume (low <5, medium 5-18, high >18). Multivariable regression model evaluated predictors of resection at a high-volume centre.
resultsIn total, 129,609 patients underwent a pancreatectomy. The crude inpatient mortality rate was 4.3%. 36.0% experienced complications. 66.5% underwent a resection at high-volume centres. In 2004, low-, medium- and high-volume centres resected 16.3%, 24.5% and 59.2% of patients, compared with 7.6%, 19.3% and 73.1% in 2011. High-volume centres had lower mortality (P < 0.001), fewer complications (P < 0.001) and a shorter median length of stay (P < 0.001). Patients at non-high-volume centres had more comorbidities (P = 0.001), lower rates of private insurance (P < 0.001) and more non-elective admissions (P < 0.001). DISCUSSION: In spite of a shift to high-volume hospitals, a substantial cohort still receives a resection outside of these centres. Patients receiving non-high-volume care demonstrate less favourable comorbidities, insurance and urgency of operation. The implications are twofold: already disadvantaged patients may not benefit from the high-volume effect; and patients predisposed to do well may contribute to observed superior outcomes at high-volume centres.
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