title: A partnership model between high- and low-volume hospitals to improve results in hepatobiliary pancreatic surgery.
abstract: OBJECTIVE
  To optimize the results of low-volume (LV) centers for hepatopancreaticobiliary (HPB) surgery.
  
  
  BACKGROUND
  High-volume (HV) centers for HPB surgery have lower mortality than LV. Strategies for collaboration between HV and LV centers are not well investigated.
  
  
  METHODS
  Postoperative outcomes of patients undergoing curative HPB resection were evaluated at an LV hospital before (2006-2008) and during the collaboration (2009-2012) and at 2 hospitals with HV for either liver or pancreatic resection (2009-2012). Itinerant tutor surgeons from the HV centers were involved in the pre-, intra- and postoperative course of HPB patients at the LV hospital.
  
  
  RESULTS
  HPB cases at the LV center increased from 18 to 40 patients per year from 2006 to 2012, whereas 6-month postoperative mortality decreased from 17.8% (2006-2008) to 6% (2009-2012), P<0.05 (liver: 10.3% vs 4.7% and pancreas: 29.4% vs 7.9%). During the collaborative study period, outcomes for hepatectomy were similar for LV and HV (85 vs 507 cases): postoperative Clavien-Dindo scores 4 and 5 were 2% and 0.2% for HV versus 2.4% and 1.2% for LV, respectively. Outcomes for pancreatic procedures (LV 63 vs HV 269 cases) showed better postoperative Clavien-Dindo scores 4 and 5 in the HV (0.7% score 4 and 1.5% score 5 for HV vs 3.2% and 6.3%, respectively, for LV) but the difference disappeared in the last 2 years (2011-2012) and matching the cases.
  
  
  CONCLUSIONS
  Our partnership model helped improve postoperative outcomes at the LV center. Results at the LV hospital were comparable with the HV centers, although 2 years of partnership were required to achieve this in pancreatic surgery.
authors.affiliation: *Department of General Surgery and Transplantation, Sant'Orsola-Malpighi Hospital, University of Bologna, Italy †Department of General Surgery, Infermi Hospital, Rimini, Italy ‡Pancreatic Surgery, Department of Surgery, IRCCS Humanitas, University of Milan, Italy §Regina Elena National Cancer Institute, Rome, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Antonio Daniele
authors.initials: AD
authors.lastname: Pinna
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Francioni
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
authors.forename: Luigi
authors.initials: L
authors.lastname: Veneroni
authors.forename: Gian Luca
authors.initials: GL
authors.lastname: Grazi
authors.forename: Gian Marco
authors.initials: GM
authors.lastname: Palini
authors.forename: Francesca
authors.initials: F
authors.lastname: Gavazzi
authors.forename: Giacomo
authors.initials: G
authors.lastname: Stacchini
authors.forename: Cristina
authors.initials: C
authors.lastname: Ridolfi
authors.forename: Matteo
authors.initials: M
authors.lastname: Serenari
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zerbi
mesh_terms: D003299:Cooperative Behavior; D006498:Hepatectomy / Q000401:mortality; D017052:Hospital Mortality; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D007558:Italy; D008107:Liver Diseases / Q000401:mortality / Q000601:surgery*; D017146:Models, Organizational; D010043:Outcome and Process Assessment, Health Care; D010180:Pancreatectomy / Q000401:mortality; D010182:Pancreatic Diseases / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D058996:Quality Improvement; D012086:Reoperation / Q000706:statistics & numerical data