title: Quality improvement of pancreatic surgery by centralization in the western part of the Netherlands.
abstract: BACKGROUND
  Centralization of pancreatic surgery in high-volume hospitals is under debate in many countries. In the western part of the Netherlands, the professional network of surgical oncologists agreed to centralize all pancreatic surgery from 2006 in two high-volume hospitals. Our aim is to evaluate whether centralization of pancreatic surgery has improved clinical outcomes and has changed referral patterns.
  
  
  METHODS
  Data of the Comprehensive Cancer Centre West (CCCW) of all 249 patients who had a resection for suspected pancreatic cancer between 1996 and 2008 in the western part of the Netherlands were analyzed. Multivariable modeling was used to evaluate survival for 3 time periods; 1996-2000, 2001-2005 (introduction of quality standards), and 2006-2008 (after centralization). In addition, the differences in referral pattern were analyzed.
  
  
  RESULTS
  From 2006, all pancreatic surgery was centralized in 2 hospitals. The 2-year survival rate increased after centralization from 39% to 55% (P =.09) for all patients who had a pancreatic resection for pancreatic cancer. After adjustment for age, tumor location, stage, histology, and adjuvant treatment, the latter period was significantly associated with improved survival (hazard ratio [HR] 0.50; 95% confidence interval [95% CI] 0.34-0.73).
  
  
  CONCLUSIONS
  Centralization of pancreatic surgery was successful and has resulted in improved clinical outcomes in the western part of the Netherlands, demonstrating the effectiveness of centralization.
authors.affiliation: Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands.
authors.forename: Gea A
authors.initials: GA
authors.lastname: Gooiker
authors.forename: Lydia G M
authors.initials: LG
authors.lastname: van der Geest
authors.forename: Michel W J M
authors.initials: MW
authors.lastname: Wouters
authors.forename: Marieke
authors.initials: M
authors.lastname: Vonk
authors.forename: Tom M
authors.initials: TM
authors.lastname: Karsten
authors.forename: Rob A E M
authors.initials: RA
authors.lastname: Tollenaar
authors.forename: Bert A
authors.initials: BA
authors.lastname: Bonsing
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D005260:Female; D017052:Hospital Mortality; D006761:Hospitals / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D017063:Outcome Assessment, Health Care; D010180:Pancreatectomy / Q000401:mortality / Q000592:standards* / Q000706:statistics & numerical data*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D058996:Quality Improvement; D015996:Survival Rate