title: Regionalization and outcomes of hepato-pancreato-biliary cancer surgery in USA.
abstract: BACKGROUND
  Recent publications demonstrate regionalization of complex operations to high-volume centers (HVCs) in the USA. We hypothesize that this pattern applies to hepato-pancreato-biliary (HPB) cancer resections and improved outcomes.
  
  
  METHODS
  The Nationwide Inpatient Sample (NIS) data were analyzed from 1995-1999(T1) to 2005-2009(T2) for all HPB oncologic resections. Division of hospitals into high-, mid-, and low-volume centers (HVC, MVC, LVC) was performed. Multivariate regression was utilized to identify predictors of LVC resection. Outcomes were compared in both eras.
  
  
  RESULTS
  A total of 45,815 cases met the inclusion criteria (19,250 from T1 and 25,565 from T2). At T1, 32.5% of resections were performed at HVCs and 34.9% at LVCs. At T2, 60.8% were performed at HVCs versus 18.5% at LVCs. In T1, inpatient mortality at HVCs versus LVCs was 3.3% versus 8.67% (p < 0.0001) and 2.7% versus 6.5% (p < 0.0001) in T2. LOS and routine discharge were improved in HVCs, but total charges were higher. All outcomes significantly differed between HVCs and LVCs in multivariate analysis, except for LOS and total charges in T2.
  
  
  CONCLUSIONS
  The most recent NIS data demonstrate better outcomes in HVCs for HPB oncologic resections. These trends reflect alignment with national recommendations to centralize complex cancer surgery, as well as improved outcomes in all centers.
authors.affiliation: Division of Gastrointestinal and Minimally Invasive Surgery, Carolinas Laparoscopic and Advanced Surgery Program, Carolinas Medical Center, 1025 Morehead Medical Drive, Suite 300, Charlotte, NC, 28204, USA.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Colavita
authors.forename: Victor B
authors.initials: VB
authors.lastname: Tsirline
authors.forename: Igor
authors.initials: I
authors.lastname: Belyansky
authors.forename: Ryan Z
authors.initials: RZ
authors.lastname: Swan
authors.forename: Amanda L
authors.initials: AL
authors.lastname: Walters
authors.forename: Amy E
authors.initials: AE
authors.lastname: Lincourt
authors.forename: David A
authors.initials: DA
authors.lastname: Iannitti
authors.forename: B Todd
authors.initials: BT
authors.lastname: Heniford
mesh_terms: D000368:Aged; D001660:Biliary Tract Diseases / Q000601:surgery; D002763:Cholecystectomy / Q000401:mortality / Q000592:standards / Q000639:trends; D016208:Databases, Factual; D005260:Female; D006498:Hepatectomy / Q000401:mortality / Q000592:standards / Q000639:trends*; D017722:Hospital Charges / Q000639:trends; D017052:Hospital Mortality / Q000639:trends; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000639:trends; D008107:Liver Diseases / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care / Q000639:trends*; D010180:Pancreatectomy / Q000401:mortality / Q000592:standards / Q000639:trends*; D010182:Pancreatic Diseases / Q000601:surgery; D010351:Patient Discharge / Q000639:trends; D012189:Retrospective Studies; D014481:United States