Trends and disparities in regionalization of pancreatic resection.
BACKGROUND
The current recommendation is that pancreatic resections be performed at hospitals doing >10 pancreatic resections annually.


OBJECTIVE
To evaluate the extent of regionalization of pancreatic resection and the factors predicting resection at high-volume centers (>10 cases/year) in Texas.


METHODS
Using the Texas Hospital Inpatient Discharge Public Use Data File, we evaluated trends in the percentage of patients undergoing pancreatic resection at high-volume centers (>10 cases/year) from 1999 to 2004 and determined the factors that independently predicted resection at high-volume centers.


RESULTS
A total of 3,189 pancreatic resections were performed in the state of Texas. The unadjusted in-hospital mortality was higher at low-volume centers (7.4%) compared to high-volume centers (3.0%). Patients resected at high-volume centers increased from 54.5% in 1999 to 63.3% in 2004 (P = 0.0004). This was the result of a decrease in resections performed at centers doing less than five resections/year (35.5% to 26.0%). In a multivariate analysis, patients who were >75 (OR = 0.51), female (OR = 0.86), Hispanic (OR = 0.58), having emergent surgery (OR = 0.39), diagnosed with periampullary cancer (OR = 0.68), and living >75 mi from a high-volume center (OR = 0.93 per 10-mi increase in distance, P < 0.05 for all OR) were less likely to be resected at high-volume centers. The odds of being resected at a high-volume center increased 6% per year.


CONCLUSIONS
Whereas regionalization of pancreatic resection at high-volume centers in the state of Texas has improved slightly over time, 37% of patients continue to undergo pancreatic resection at low-volume centers, with more than 25% occurring at centers doing less than five per year. There are obvious demographic disparities in the regionalization of care, but additional unmeasured barriers need to be identified.
Riall
Taylor S
TS
Department of Surgery, University of Texas Medical Branch, 301 University Boulevard, Galveston, TX 77555-0542, USA. tsriall@utmb.edu
Eschbach
Karl A
KA
Townsend
Courtney M
CM
Nealon
William H
WH
Freeman
Jean L
JL
Goodwin
James S
JS
D000230:Adenocarcinoma / Q000601:surgery; D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D054625:Healthcare Disparities / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006752:Hospital Planning; D006801:Humans; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010180:Pancreatectomy / Q000401:mortality* / Q000592:standards / Q000706:statistics & numerical data*; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000401:mortality* / Q000592:standards / Q000706:statistics & numerical data*; D012040:Regional Health Planning; D012720:Severity of Illness Index; D013781:Texas / Q000453:epidemiology
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