Temporal trends and volume-outcome associations in periampullary cancer patients: a propensity score-adjusted nationwide population-based study.
BACKGROUND
The purpose of this study was to evaluate temporal trends in the incidence of pancreaticoduodenectomy (PD) with periampullary cancers and the impact of hospital volume and surgeon volume on patient outcomes and to explore predictors of these outcomes.


METHODS
This population-based cohort study retrospectively analyzed 4,039 PD procedures performed from 1998 to 2009. The odds ratio and 95% confidence interval were calculated to assess the relative change rate. Hierarchical regression models were used to predict these outcomes.


RESULTS
The incidence of PDs per 10(5) persons increased from .97 to 1.89, whereas the length of stay and hospital treatment cost declined. Current treatment in a low-volume hospital and current treatment by a low-volume surgeon showed significant positive associations with these outcomes (P < .001).


CONCLUSIONS
The data indicate that analysis and emulation of the treatment strategies used by high-volume hospitals and high-volume surgeons may reduce overall hospital resource use. Because high-volume hospitals and surgeons consistently achieve superior outcomes of PD, their treatment strategies should be carefully analyzed and emulated.
Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, San Ming District, Kaohsiung 80708, Taiwan.
Hon-Yi
HY
Shi
Division of Hepatobiliary Surgery, Department of Surgery, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, San Ming District, Kaohsiung 80708, Taiwan; College of Medicine, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, San Ming District, Kaohsiung 80708, Taiwan.
Shen-Nien
SN
Wang
Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, San Ming District, Kaohsiung 80708, Taiwan; Division of Hepatobiliary Surgery, Department of Surgery, Kaohsiung Medical University, 100 Shih-Chuan 1st Road, San Ming District, Kaohsiung 80708, Taiwan. Electronic address: hshi@kmu.edu.tw.
King-Teh
KT
Lee
D000368:Aged; D014670:Ampulla of Vater / Q000601:surgery*; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D004379:Duodenal Neoplasms / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D061847:Hospitals, High-Volume / Q000592:standards*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000639:trends*; D011159:Population Surveillance; D057216:Propensity Score; D012189:Retrospective Studies; D013624:Taiwan; D016526:Workload
Outcomes; Pancreaticoduodenectomy; Temporal trends; Volumes