title: High-volume surgeons vs high-volume hospitals: are best outcomes more due to who or where?
abstract: BACKGROUND
  High-volume hospitals are purported to provide "best" outcomes. We undertook this study to evaluate the outcomes after pancreaticoduodenectomy when high-volume surgeons relocate to a low-volume hospital (ie, no pancreaticoduodenectomies in >5 years).
  
  
  METHODS
  Outcomes after the last 50 pancreaticoduodenectomies undertaken at a high-volume hospital in 2012 (ie, before relocation) were compared with the outcomes after the first 50 pancreaticoduodenectomies undertaken at a low-volume hospital (ie, after relocation) in 2012 to 2013.
  
  
  RESULTS
  Patients undergoing pancreaticoduodenectomies at a high-volume vs a low-volume hospital were not different by age or sex. Patients who underwent pancreaticoduodenectomy at the low-volume hospital had shorter operations with less blood loss, spent less time in the intensive care unit, and had shorter length of stay (P < .05 for each); 30-day mortality and 30-day readmission rates were not different.
  
  
  CONCLUSIONS
  The salutary benefits of undertaking pancreaticoduodenectomy at a high-volume hospital are transferred to a low-volume hospital when high-volume surgeons relocate. The "best" results follow high-volume surgeons.
authors.affiliation: Department of General Surgery, Florida Hospital Tampa, 3000 Medical Park Drive Suite 310, Tampa, FL, 33613, USA.
authors.forename: Paul G
authors.initials: PG
authors.lastname: Toomey
authors.affiliation: Department of General Surgery, Florida Hospital Tampa, 3000 Medical Park Drive Suite 310, Tampa, FL, 33613, USA.
authors.forename: Anthony F
authors.initials: AF
authors.lastname: Teta
authors.affiliation: Department of General Surgery, Florida Hospital Tampa, 3000 Medical Park Drive Suite 310, Tampa, FL, 33613, USA.
authors.forename: Krishen D
authors.initials: KD
authors.lastname: Patel
authors.affiliation: Department of General Surgery, Florida Hospital Tampa, 3000 Medical Park Drive Suite 310, Tampa, FL, 33613, USA.
authors.forename: Sharona B
authors.initials: SB
authors.lastname: Ross
authors.affiliation: Department of General Surgery, Florida Hospital Tampa, 3000 Medical Park Drive Suite 310, Tampa, FL, 33613, USA. Electronic address: arosemurgy@hotmail.com.
authors.forename: Alexander S
authors.initials: AS
authors.lastname: Rosemurgy
mesh_terms: D000328:Adult; D000368:Aged; D003422:Critical Care / Q000706:statistics & numerical data; D005260:Female; D005500:Follow-Up Studies; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D016577:Pancreaticoduodenectomy / Q000401:mortality; D010359:Patient Readmission / Q000706:statistics & numerical data; D011446:Prospective Studies; D066231:Surgeons / Q000706:statistics & numerical data* / Q000600:supply & distribution; D014481:United States; D000078329:Workforce
keywords: High-volume hospitals; High-volume surgeons; Leapfrog; Low-volume hospitals; Low-volume surgeons; Pancreaticoduodenectomy