Publications (2)4.61 Total impact
-
Article: Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality.
[show abstract] [hide abstract]
ABSTRACT: The impact of nationwide centralization of pancreaticoduodenectomy (PD) on mortality is largely unknown. The aim of this study was to analyse changes in hospital volumes and in-hospital mortality after PD in the Netherlands between 2004 and 2009. Nationwide data on International Classification of Diseases, ninth revision (ICD-9) code 5-526 (PD, including Whipple), patient age, sex and mortality were retrieved from the independent nationwide KiwaPrismant registry. Based on established cut-off points of annually performed PDs, hospitals were categorized as very low (fewer than 5), low (5-10), medium (11-19) or high (at least 20) volume. A subgroup analysis based on a cut-off age of 70 years was also performed. Some 2155 PDs were included. The number of hospitals performing PD decreased from 48 in 2004 to 30 in 2009 (P = 0·011). In these specific years, the proportion of patients undergoing PD in a medium- or high-volume centre increased from 52·9 to 91·2 per cent (P < 0·001). Nationwide mortality rates after PD decreased from 9·8 to 5·1 per cent (P = 0·044). The mortality rate during the 6-year period was 14·7, 9·8, 6·3 and 3·3 per cent in very low-, low-, medium- and high-volume hospitals respectively (P < 0·001). The difference in mortality between medium- and high-volume centres was statistically significant (P = 0·004). The volume-outcome relationship was not influenced by age (P = 0·467). The mortality rate after PD in patients aged at least 70 years was 10·4 per cent compared with 4·4 per cent in younger patients (P < 0·001). With nationwide centralization of PD, the in-hospital mortality rate after this procedure decreased. Further centralization of PD is likely to decrease mortality further, especially in the elderly.British Journal of Surgery 03/2012; 99(3):404-10. · 4.61 Impact Factor -
Article: [Centralisation of pancreaticoduodenectomy in the Netherlands has reduced post-operative mortality].
[show abstract] [hide abstract]
ABSTRACT: To analyse the extent of centralisation of pancreaticoduodenectomy (Whipple procedure) and changes in in-hospital mortality rates in the Netherlands. Retrospective analysis. Data on patients who had undergone pancreaticoduodenectomy (PD) during the 2004-2009 period was acquired from the Kiwa Prismant registry. Based on the number of procedures performed annually, hospitals were divided into 4 volume-categories: very-low (<5), low (5-10), medium (11-19) and high (≥20). Changes in volume and in-hospital mortality were analysed per volume category. A subgroup analysis based on age was also performed. 2155 patients who had undergone PD were included. The number of hospitals performing PD decreased from 48 in 2004 to 30 in 2009 (p = 0.01). The proportion of patients who had undergone PD in a medium- or high-volume hospital increased from 52.9% to 91.2% (p < 0.001). Post-operative mortality rates decreased from 9.8% to 5.1% (p = 0.04). Average mortality was 14.7%, 9.8%, 6.3% and 3.3% in very low-, low-, medium-, and high-volume hospitals, respectively (p < 0.001). The difference in mortality between medium- and high-volume hospitals was statistically significant (p = 0.004). The mortality rate in patients ≥ 70 years was 10.4% compared with 4.4% in younger patients (p < 0.001). CONCLUSION : Nationwide centralisation of PD is occurring in Netherlands, and this is associated with a decrease in in-hospital mortality. Further centralisation is likely to further decrease in-hospital mortality, especially in the elderly.Nederlands tijdschrift voor geneeskunde 01/2012; 156(32):A4791.
