title: Relative impact of surgeon and hospital volume on operative mortality and complications following pancreatic resection in Medicare patients.
abstract: Surgeon and hospital volume are both known to affect outcomes for patients undergoing pancreatic resection. The objective was to evaluate the relative effects of surgeon and hospital volume on 30-d mortality and 30-d complications after pancreatic resection among older patients.
  
  
  
  The study used Texas Medicare data (2000-2012), identifying high-volume surgeons as those performing ≥4 pancreatic resections/year, and high-volume hospitals as those performing ≥11 pancreatic resections/year, on Medicare patients. Three-level hierarchical logistic regression models were used to evaluate the relative effects of surgeon and hospital volumes on mortality and complications, after adjusting for case mix differences.
  
  
  
  There were 2453 pancreatic resections performed by 490 surgeons operating in 138 hospitals. Of the total, 4.5% of surgeons and 6.5% of hospitals were high volume. The overall 30-d mortality was 9.0%, and the 30-d complication rate was 40.6%. Overall, 8.9% of the variance in 30-d mortality was attributed to surgeon factors and 9.8% to hospital factors. For 30-d complications, 4.7% of the variance was attributed to surgeon factors and 1.2% to hospital factors. After adjusting for patient, surgeon, and hospital characteristics, high surgeon volume (odds ratio [OR] = 0.54, 95% confidence interval [CI], 0.33-0.87) and high hospital volume (OR = 0.52; 95% CI, 0.30-0.92) were associated with lower risk of mortality; high surgeon volume (OR = 0.71, 95% CI, 0.55-0.93) was also associated lower risk of 30-d complications.
  
  
  
  Both hospital and surgeon factors contributed significantly to the observed variance in mortality, but only surgeon factors impacted complications.
authors: Department of Surgery, University of Texas Medical Branch, Galveston, Texas. Electronic address: hbmehta@utmb.edu.
authors: Hemalkumar B
authors: HB
authors: Mehta
authors: Department of Surgery, University of California, Oakland, California.
authors: Abhishek D
authors: AD
authors: Parmar
authors: Department of Surgery, University of Texas Medical Branch, Galveston, Texas; Office of Biostatistics, Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.
authors: Deepak
authors: D
authors: Adhikari
authors: Department of Surgery, University of Texas Medical Branch, Galveston, Texas.
authors: Nina P
authors: NP
authors: Tamirisa
authors: Department of Surgery, University of Texas Medical Branch, Galveston, Texas; Department of Surgery, University of South Florida, Tampa, Florida.
authors: Francesca
authors: F
authors: Dimou
authors: Department of Preventive Medicine and Community Health, University of Texas Medical Branch, Galveston, Texas.
authors: Daniel
authors: D
authors: Jupiter
authors: Department of Surgery, University of Arizona, College of Medicine-Tucson, Tucson, Arizona.
authors: Taylor S
authors: TS
authors: Riall
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D016015:Logistic Models; D008297:Male; D006278:Medicare; D010180:Pancreatectomy / Q000401:mortality*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D066231:Surgeons / Q000706:statistics & numerical data*; D013781:Texas / Q000453:epidemiology; D014481:United States
keywords: Complications; Hospital volume; Mortality; Multilevel models; Pancreatic resection; Surgeon volume