title: Frequency with which surgeons undertake pancreaticoduodenectomy continues to determine length of stay, hospital charges, and in-hospital mortality.
abstract: BACKGROUND
  This study was undertaken to determine changes in the frequency of, volume of, and outcomes after pancreaticoduodenectomy 6 years after a study denoted that, in Florida, the frequency and volume of pancreaticoduodenectomy impacted outcome.
  
  
  METHODS
  Using the State of Florida Agency for Health Care Administration database, the frequency and volume of pancreaticoduodenectomy was correlated with average length of hospital stay (ALOS), in-hospital mortality, and hospital charges for identical periods in 1995-1997 and 2003-2005.
  
  
  RESULTS
  Compared to 1995-1997, 88% more pancreaticoduodenectomy was performed in 2003-2005 by 6% fewer surgeons; the majority of pancreaticoduodenectomies were conducted by surgeons doing <1 pancreaticoduodenectomy every 2 months. In-hospital mortality rate did not decrease from 1995-1997 to 2003-2005 (5.1 to 5.9%); in-hospital mortality rate increased for surgeons undertaking <1 pancreaticoduodenectomy every 2 months (5.5 to 12.3%, p<0.01). For 2003-2005, frequency with which pancreaticoduodenectomy is conducted inversely correlates with ALOS (p=0.001), hospital charges (p=0.001), and in-hospital mortality (p=0.001).
  
  
  CONCLUSIONS
  In Florida, more pancreaticoduodenectomies are carried out by fewer surgeons. Mortality has not decreased because of surgeons infrequently performing pancreaticoduodenectomy. Most pancreaticoduodenectomies are still undertaken by surgeons who conduct pancreaticoduodenectomy infrequently with greater lengths of stay, hospital costs, and in-hospital mortality rates. To an even greater extent than previously documented, patients are best served by surgeons frequently performing pancreaticoduodenectomy.
authors.affiliation: Digestive Disorders Center, Tampa General Hospital, University of South Florida, Tampa, FL 33601, USA. arosemur@hsc.usf.edu
authors.forename: Alexander
authors.initials: A
authors.lastname: Rosemurgy
authors.forename: Sarah
authors.initials: S
authors.lastname: Cowgill
authors.forename: Brian
authors.initials: B
authors.lastname: Coe
authors.forename: Ashley
authors.initials: A
authors.lastname: Thomas
authors.forename: Sam
authors.initials: S
authors.lastname: Al-Saadi
authors.forename: Steven
authors.initials: S
authors.lastname: Goldin
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Zervos
mesh_terms: D000368:Aged; D002983:Clinical Competence; D015897:Comorbidity; D005431:Florida; D017722:Hospital Charges / Q000706:statistics & numerical data*; D017052:Hospital Mortality; D006785:Hospitals, University / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data* / Q000639:trends; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000191:economics / Q000401:mortality / Q000706:statistics & numerical data* / Q000639:trends; D010818:Practice Patterns, Physicians'; D012189:Retrospective Studies