title: Is Illinois heeding the call to regionalize pancreatic surgery?
abstract: OBJECTIVE
  Recommendations to refer pancreatic procedures to high-volume centers have been in place for a decade. We sought to determine whether regionalization of pancreatic procedures to high-volume centers is occurring in Illinois.
  
  
  METHODS
  We compared pancreatic procedures performed in Illinois hospitals from 2000 to 2004 [time period (TP) 1] versus 2005-2009 (TP2) for changes in inpatient mortality and hospital volume. Hospitals were categorized into low- (LVH), intermediate- (IVH), or high-volume (HVH).
  
  
  RESULTS
  From TP1 to TP2, there was a 23% increase in absolute case volume (2,232-2,737), despite fewer hospitals performing pancreatic procedures (114-95). In hospital mortality decreased (5.5-3.3%, P < 0.01) and was lowest at HVHs. LVHs and IVHs were associated with a 4.7 and 3.0 higher odds of mortality, respectively (both P < 0.001). Overall, HVHs performed 659 (+73%) more procedures, whereas cumulative procedure volume dropped by 154 cases at LVHs (+1%) and IVHs (-18%).
  
  
  CONCLUSIONS
  We observed limited evidence of regionalization of pancreatic procedures in Illinois. The increase in HVH case volume cannot be solely attributed to regionalization, given the corresponding modest decrease seen at non-HVHs. There is opportunity for Illinois hospitals to implement strategies such as selective referral to improve mortality after pancreatic resection.
authors: Department of Surgery, Northwestern University Feinberg School of Medicine, Jesse Brown VA Medical Center, Chicago, Illinios, USA.
authors: Amanda V
authors: AV
authors: Hayman
authors: Matthew J
authors: MJ
authors: Fisher
authors: Thomas
authors: T
authors: Kluz
authors: Ryan P
authors: RP
authors: Merkow
authors: Edward C
authors: EC
authors: Wang
authors: David J
authors: DJ
authors: Bentrem
mesh_terms: D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007087:Illinois / Q000453:epidemiology; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D010180:Pancreatectomy / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data / Q000639:trends; D010182:Pancreatic Diseases / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000601:surgery; D012017:Referral and Consultation / Q000592:standards / Q000639:trends