This is the Scientific Surgery Archive, which contains all randomized clinical trials in surgery that have been identified by searching the top 50 English language medical journal issues since January 1998. Compiled by Jonothan J. Earnshaw, former Editor-in-Chief, BJS
Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy. BJS 2008; 95: 357-362.
Published: 12th October 2007
Authors: G. Balzano, A. Zerbi, G. Capretti, S. Rocchetti, V. Capitanio, V. Di Carlo et al.
Background
An inverse relationship between hospital volume and death following pancreatico duodenectomy (PD) has been reported from several countries. The aim of this study was to assess the volume–outcome effect of PD in Italy.
Method
The study group comprised 1576 patients who underwent PD in 2003. Hospitals were allocated to four volume groups: low volume, five PDs or fewer; medium volume, six to 13 PDs; high volume, 14 to 51 PDs; and very high volume, two hospitals that performed 89 and 104 PDs.
Results
Some 221 hospitals performed at least one PD in 2003; hospital volume was low in 74·7 per cent, medium in 17·6 per cent, high in 6·8 per cent and very high in 0·9 per cent. The overall mortality rate was 8·1 per cent. Increasing hospital volume was associated with a significantly reduced mortality rate: 12·4 per cent (adjusted odds ratio (OR) 1·000) for low‐volume, 7·8 per cent (OR 0·611) for medium‐volume, 5·9 per cent (OR 0·466) for high‐volume and 2·6 per cent (OR 0·208) for very high‐volume hospitals. Length of postoperative stay was reduced in very high‐volume hospitals (P < 0·001).
Conclusion
The outcome of PD in Italy is dependent on hospital volume and a policy of centralization may therefore be appropriate. Copyright © 2007 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
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