title: Surgeon volume versus morbidity and cost in patients undergoing pancreaticoduodenectomy in an academic community medical center.
abstract: BACKGROUND
  Despite trends toward regionalization of care, the majority of pancreaticoduodenectomies (PD) are performed in community hospitals by surgeons with varying degrees of experience. We analyzed the impact of several variables, including surgeon volume, on outcomes following PD within a high-volume community-based teaching hospital system.
  
  
  METHODS
  Patients who underwent PD from 2005 to 2008 were reviewed retrospectively. Perioperative data, complications, and hospital financial data was queried. A high-volume (HV) surgeon was defined as an average of 10 or more PD per year.
  
  
  RESULTS
  Ninety-four patients underwent PD with an overall operative mortality rate of 9.6% (HV 2.2%, LV 16.0%), major complication rate of 32% (HV 18%, LV 44%), and median cost of $30,860 (HV $27,185, LV $33,007). Factors predictive of death were age (p < 0.02), body mass index (p < 0.01), and surgeon volume (p < 0.05). Factors predictive of major complication were surgeon volume (p < 0.01) and body mass index (p < 0.01). Factors predictive for increased length of stay for patients discharged from the hospital were surgeon volume (p < 0.02) and preoperative ASA classification (p < 0.05).
  
  
  CONCLUSIONS
  Surgeon volume and patient body mass index have a significant impact on perioperative morbidity following PD in a community teaching hospital.
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Portland Medical Center, Portland, OR, USA.
authors.forename: Timothy J
authors.initials: TJ
authors.lastname: Kennedy
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cassera
authors.forename: Ronald
authors.initials: R
authors.lastname: Wolf
authors.forename: Lee L
authors.initials: LL
authors.lastname: Swanstrom
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hansen
mesh_terms: D000368:Aged; D003365:Costs and Cost Analysis; D004386:Duodenum / Q000601:surgery*; D005260:Female; D006764:Hospitals, Community; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects / Q000191:economics* / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D012189:Retrospective Studies