ArticleAnnals of surgical treatment and research2026
Hospital surgical volume, perioperative transfusion, and 30-day mortality after pancreatic surgery: a nationwide population-based retrospective cohort study in South Korea.
Article in Annals of surgical treatment and research, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
Purpose: We evaluated national trends in 30-day mortality following pancreatic surgery and the factors associated with 30-day mortality in South Korea, with special attention to hospital surgical volume and perioperative transfusion as perioperative risk markers. Methods: We performed a retrospective, population-based study using Korean National Health Insurance Service data. Adults who underwent pancreatic surgery during 2012-2020 were included (n = 40,937). The annual 30-day mortality rates were described overall and stratified by year, age, sex, and pancreatic surgical procedure. We analyzed the associations between hospital surgical volume, perioperative transfusion, and 30-day mortality. Results: The annual number of pancreatic surgeries increased from 4,055 in 2012 to 5,278 in 2020, whereas 30-day mortality remained stable (1.2%-1.9%, P-trend = 0.401). Mortality was lowest in high-volume hospitals (1.0%) and highest in the lowest-volume hospitals (5.9%). Perioperative transfusion and greater transfusion volume were strongly associated with increased 30-day mortality; both were more frequent and of greater quantities in lower-volume hospitals. Across the transfusion strata, a higher hospital surgical volume was consistently associated with lower mortality. In multivariable analyses, lower hospital volume and greater transfusion volume were independently associated with increased 30-day mortality, demonstrating a clear volume-outcome gradient and dose-response relationship with the transfusion amount. Conclusion: Despite the increasing surgical volume nationwide, the 30-day mortality after pancreatic surgery in South Korea remained unchanged. Lower hospital volume and perioperative transfusion independently predicted increased 30-day mortality. Given lower transfusion rates in high-volume hospitals, these findings support centralizing pancreatic surgery in specialized centers and highlight the importance of optimized perioperative management.
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