title: Surgery residency training programmes have greater impact on outcomes after pancreaticoduodenectomy than hospital volume or surgeon frequency.
abstract: BACKGROUND
  Hospital volume of pancreaticoduodenectomy (PD) and surgeon frequency of PD have been shown to impact outcomes. The impact of surgery residency training programmes after PD is unknown. This study was undertaken to determine the impact of surgery training programmes on outcomes after PD, as well as their importance relative to hospital volume and surgeon frequency of PD.
  
  
  METHODS
  The State of Florida Agency for Healthcare Administration Database was queried for patients undergoing PD during 2002-2007. Measures of outcome were compared for patients undergoing PD at centres with vs. without surgery residency training programmes.
  
  
  RESULTS
  A total of 2345 PDs were identified, of which 1478 (63%) were undertaken at training centres and 867 (37%) were performed at non-training centres. Patients undergoing PD at training centres had shorter lengths of stay, lower hospital charges and lower in-hospital mortality. Relative to surgeon frequency of PD, training centres had a greater favourable impact on hospital length of stay, hospital charges and in-hospital mortality (P < 0.001 for each, ancova). Relative to hospital volume of PDs undertaken, training centres had a greater impact on hospital charges (P < 0.001, ancova).
  
  
  CONCLUSIONS
  Surgery residency training programmes have a favourable effect on outcomes following PD and their impact on outcome is greater than the impact of hospital volume or surgeon frequency of PD.
authors.affiliation: Digestive Disorders Center, Tampa General Hospital, Tampa, FL 33601, USA.
authors.forename: Whalen
authors.initials: W
authors.lastname: Clark
authors.forename: Jonathan
authors.initials: J
authors.lastname: Hernandez
authors.forename: Bri Anne
authors.initials: BA
authors.lastname: McKeon
authors.forename: Alyssa
authors.initials: A
authors.lastname: Kahn
authors.forename: Connor
authors.initials: C
authors.lastname: Morton
authors.forename: Paul
authors.initials: P
authors.lastname: Toomey
authors.forename: John
authors.initials: J
authors.lastname: Mullinax
authors.forename: Sharona
authors.initials: S
authors.lastname: Ross
authors.forename: Alexander
authors.initials: A
authors.lastname: Rosemurgy
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D016009:Chi-Square Distribution; D002983:Clinical Competence; D015897:Comorbidity; D003479:Curriculum; D004503:Education, Medical, Graduate; D005260:Female; D005431:Florida; D017052:Hospital Mortality; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D007396:Internship and Residency; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care / Q000706:statistics & numerical data; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000193:education* / Q000401:mortality; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome