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Is Illinois heeding the call to regionalize pancreatic surgery?
Author(s) -
Hayman Amanda V.,
Fisher Matthew J.,
Kluz Thomas,
Merkow Ryan P.,
Wang Edward C.,
Bentrem David J.
Publication year - 2013
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23310
Subject(s) - medicine , odds ratio , referral , odds , general surgery , emergency medicine , surgery , logistic regression , family medicine
Background and Objectives Recommendations to refer pancreatic procedures to high‐volume centers have been in place for a decade. We sought to determine whether regionalization of pancreatic procedures to high‐volume centers is occurring in Illinois. Methods We compared pancreatic procedures performed in Illinois hospitals from 2000 to 2004 [time period (TP) 1] versus 2005–2009 (TP2) for changes in inpatient mortality and hospital volume. Hospitals were categorized into low‐ (LVH), intermediate‐ (IVH), or high‐volume (HVH). Results From TP1 to TP2, there was a 23% increase in absolute case volume (2,232–2,737), despite fewer hospitals performing pancreatic procedures (114–95). In hospital mortality decreased (5.5–3.3%, P < 0.01) and was lowest at HVHs. LVHs and IVHs were associated with a 4.7 and 3.0 higher odds of mortality, respectively (both P < 0.001). Overall, HVHs performed 659 (+73%) more procedures, whereas cumulative procedure volume dropped by 154 cases at LVHs (+1%) and IVHs (−18%). Conclusions We observed limited evidence of regionalization of pancreatic procedures in Illinois. The increase in HVH case volume cannot be solely attributed to regionalization, given the corresponding modest decrease seen at non‐HVHs. There is opportunity for Illinois hospitals to implement strategies such as selective referral to improve mortality after pancreatic resection. J. Surg. Oncol. 2013;107:685–691. © 2013 Wiley Periodicals, Inc.