title: Pancreaticoduodenectomy--the transition from a low- to a high-volume center.
abstract: OBJECTIVE
  Previous studies have identified a significant volume-outcome relationship for hospitals performing pancreaticoduodenectomy (PD). However, scant information exists concerning the effects of increased caseload of PD within the same hospital. Here, we describe the effects of becoming a high-volume provider of PD.
  
  
  METHODS
  The study group comprised 221 patients who underwent PD between 2000 and 2012. Hospital volume was allocated into three groups: low-volume (<10 PDs/year), years 2000-2004, n = 25; medium-volume (10-24 PDs/year), years 2005-2009, n = 86; and high-volume (≥25 PDs/year), years 2010-2012, n = 110.
  
  
  RESULTS
  The annual number of PDs increased from 5 in 2000 to 39 in 2012. The median operative duration decreased over the volume categories (p < 0.001). Intraoperative blood loss dropped (p < 0.001). The need for intraoperative blood transfusion was reduced (p < 0.001). Increasing hospital volume was associated with fewer reoperations (p = 0.041) and shorter postoperative length of stay (p = 0.010). There was a tendency toward reduced mortality: 4.0% for the low-volume period, 2.3% for the medium-volume period, and 0% for the high-volume period (p = 0.066).
  
  
  CONCLUSIONS
  The transition from a low- to a high-volume center resulted in optimized outcomes for PD and 0% operative mortality, favoring the continued centralization of this high-risk operation.
authors.affiliation: Department of Surgery, Clinical Sciences Lund, Lund University, Skåne University Hospital , Lund , Sweden.
authors.forename: Daniel
authors.initials: D
authors.lastname: Ansari
authors.forename: Caroline
authors.initials: C
authors.lastname: Williamsson
authors.forename: Bobby
authors.initials: B
authors.lastname: Tingstedt
authors.forename: Bodil
authors.initials: B
authors.lastname: Andersson
authors.forename: Gert
authors.initials: G
authors.lastname: Lindell
authors.forename: Roland
authors.initials: R
authors.lastname: Andersson
mesh_terms: D005260:Female; D005743:Gastrectomy; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D016577:Pancreaticoduodenectomy / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D012086:Reoperation / Q000706:statistics & numerical data; D012189:Retrospective Studies; D013548:Sweden; D016896:Treatment Outcome