title: Overuse of surgery in patients with pancreatic cancer. A nationwide analysis in Italy.
abstract: According to current guidelines, pancreatic cancer patients should be strictly selected for surgery, either palliative or resective.
  
  
  
  Population-based study, including all patients undergoing surgery for pancreatic cancer in Italy between 2010 and 2012. Hospitals were divided into five volume groups (quintiles), to search for differences among volume categories.
  
  
  
  There were 544 hospitals performing 10 936 pancreatic cancer operations. The probability of undergoing palliative/explorative surgery was inversely related to volume, being 24.4% in very high-volume hospitals and 62.5% in very low-volume centres (adjusted OR 5.175). Contrarily, the resection rate in patients without metastases decreased from 86.9% to 46.1% (adjusted OR 7.429). As for resections, the mortality of non-resective surgery was inversely related to volume (p < 0.001). Surprisingly, mortality of non-resective surgery was higher than that for resections (8.2% vs. 6.7%; p < 0.01). Approximately 9% of all resections were performed on patients with distant metastases, irrespective of hospital volume group. The excess cost for the National Health System from surgery overuse was estimated at 12.5 million euro.
  
  
  
  Discrepancies between guidelines on pancreatic cancer treatment and surgical practice were observed. An overuse of surgery was detected, with serious clinical and economic consequences.
authors.affiliation: Unit of Pancreatic Surgery, San Raffaele Scientific Institute, Milan, Italy; Italian Association for the Study of Pancreas (AISP), Italy. Electronic address: balzano.gianpaolo@hsr.it.
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Balzano
authors.affiliation: Unit of Pancreatic Surgery, San Raffaele Scientific Institute, Milan, Italy; Italian Association for the Study of Pancreas (AISP), Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Capretti
authors.affiliation: Centre for Research on Health and Social Care Management (CERGAS), Università Commerciale Luigi Bocconi, Milan, Italy.
authors.forename: Giuditta
authors.initials: G
authors.lastname: Callea
authors.affiliation: Centre for Research on Health and Social Care Management (CERGAS), Università Commerciale Luigi Bocconi, Milan, Italy.
authors.forename: Elena
authors.initials: E
authors.lastname: Cantù
authors.affiliation: Directorate of Health Care Planning, Ministry of Health, Roma, Italy; Centre of Epidemiology, Biostatistics and Information Technology, Università Politecnica delle Marche, Ancona, Italy.
authors.forename: Flavia
authors.initials: F
authors.lastname: Carle
authors.affiliation: Italian Association for the Study of Pancreas (AISP), Italy; Pancreas Unit, Department of Digestive Diseases and Internal Medicine, Sant'Orsola-Malpighi Hospital, Bologna, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Pezzilli
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016009:Chi-Square Distribution; D017046:Cost Savings; D003362:Cost-Benefit Analysis; D005260:Female; D019983:Guideline Adherence; D017048:Health Care Costs; D019538:Health Care Surveys; D006302:Health Services Research; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D007558:Italy; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010180:Pancreatectomy / Q000191:economics / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data*; D010190:Pancreatic Neoplasms / Q000191:economics / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000191:economics / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data*; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000191:economics / Q000592:standards; D017064:Process Assessment, Health Care / Q000191:economics / Q000592:standards; D012307:Risk Factors; D066231:Surgeons / Q000191:economics / Q000592:standards; D013997:Time Factors; D016896:Treatment Outcome; D019564:Unnecessary Procedures / Q000191:economics / Q000592:standards / Q000706:statistics & numerical data*