title: Pancreatic Resection Results in a Statewide Surgical Collaborative.
abstract: BACKGROUND
  A strong relationship between hospital caseload and adverse outcomes has been demonstrated for pancreatic resections. Participation in regional surgical collaboratives may mitigate this phenomenon. This study sought to investigate changes over time in adverse outcomes after pancreatectomy across hospitals with different caseloads in a statewide surgical collaborative.
  
  
  METHODS
  The study investigated patients undergoing pancreatic resection from January 2008 to August 2013 at Michigan Surgical Quality Collaborative (MSQC) hospitals (1007 patients in 19 academic and community hospitals). Risk-adjusted rates of major complications, mortality, and failure to rescue were compared between hospitals based on caseloads (low, medium, and high) in early (2008-2010) and later (2011-2013) periods. Finally, the degree to which different complications explained changes in hospital outcome variation was assessed.
  
  
  RESULTS
  Adjusted rates of major complications and mortality decreased over time, driven largely by improvements at low-caseload hospitals. In 2008-2010, risk-adjusted major complication rates were higher for low-caseload than for high-caseload hospitals (27.8 vs. 17.8 %; p = 0.02). However, these differences were attenuated in 2011-2013 (22.2 vs. 20.0 %; p = 0.74). Similarly, adjusted mortality rates were higher in low-caseload hospitals in 2008-2010 (6.2 vs. 0.8 %; p = 0.02), but these differences were attenuated in 2011-2013 (3.3 vs. 1.1 %; p = 0.18). Variation in major complications decreased, largely due to decreased variation in "medical" complication rates, with less change in surgical-site complications.
  
  
  CONCLUSIONS
  Participation in regional quality collaboratives by lower-volume hospitals can attenuate the volume-outcome relationship for pancreatic surgery. Continued work in collaboratives with an emphasis on technical and intraoperative aspects of care may improve overall quality of care.
authors.affiliation: Department of Surgery, Center for Healthcare Outcomes & Policy, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Healy
authors.forename: Robert W
authors.initials: RW
authors.lastname: Krell
authors.forename: Zaid M
authors.initials: ZM
authors.lastname: Abdelsattar
authors.forename: Laurence E
authors.initials: LE
authors.lastname: McCahill
authors.forename: David
authors.initials: D
authors.lastname: Kwon
authors.forename: Timothy L
authors.initials: TL
authors.lastname: Frankel
authors.forename: Samantha
authors.initials: S
authors.lastname: Hendren
authors.forename: Darrell A
authors.initials: DA
authors.lastname: Campbell
authors.forename: Sandra L
authors.initials: SL
authors.lastname: Wong
mesh_terms: D000368:Aged; D003299:Cooperative Behavior; D000067248:Failure to Rescue, Health Care / Q000706:statistics & numerical data; D005260:Female; D061847:Hospitals, High-Volume / Q000592:standards / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008824:Michigan; D008875:Middle Aged; D010180:Pancreatectomy / Q000009:adverse effects* / Q000401:mortality* / Q000592:standards; D058996:Quality Improvement / Q000639:trends*; D012041:Regional Medical Programs; D012042:Registries
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