title: Pancreaticoduodenectomy: A study from India on the impact of evolution from a low to a high volume unit.
abstract: OBJECTIVE
  To analyse the impact of turning of our department from a low to a high volume provider of pancreaticoduodenectomy (PD) on surgical outcome.
  
  
  METHODS
  A retrospective collection of data was done for patients who underwent PD. According to the number of PDs undertaken per year, we categorized the volume into low volume (< 10 PDs/year), medium volume (10-24 PDs/year) and high volume (> 25 PDs/year) groups.
  
  
  RESULTS
  From 2002 to 2013, 200 patients underwent PD. The annual number of PD increased from 4 in 2002 to 34 in 2013. The mean operative time, operative blood loss and need for intraoperative blood transfusion decreased considerably over the volume categories (P < 0.001, P < 0.001 and P < 0.001, respectively). Increased procedural volume was associated with a lower morbidity (P = 0.021) and shorter length of hospital stay (P < 0.001). Similarly the rate of mortality dropped from 10% for the low volume group to 2.2% for the medium volume group and 0.0% for the high volume group (P = 0.007).
  
  
  CONCLUSIONS
  The transformation from a low volume to a high volume provider of PD resulted in most favourable outcomes favouring the continued centralization of this high risk procedure.
authors.affiliation: Omar J Shah, Manmohan Singh, Mohammad R Lattoo, Sadaf A Bangri, Department of Surgical Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190011, India.
authors.forename: Omar J
authors.initials: OJ
authors.lastname: Shah
authors.affiliation: Omar J Shah, Manmohan Singh, Mohammad R Lattoo, Sadaf A Bangri, Department of Surgical Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190011, India.
authors.forename: Manmohan
authors.initials: M
authors.lastname: Singh
authors.affiliation: Omar J Shah, Manmohan Singh, Mohammad R Lattoo, Sadaf A Bangri, Department of Surgical Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190011, India.
authors.forename: Mohammad R
authors.initials: MR
authors.lastname: Lattoo
authors.affiliation: Omar J Shah, Manmohan Singh, Mohammad R Lattoo, Sadaf A Bangri, Department of Surgical Gastroenterology, Sher-i-Kashmir Institute of Medical Sciences, Srinagar, Kashmir 190011, India.
authors.forename: Sadaf A
authors.initials: SA
authors.lastname: Bangri
keywords: High volume centre; Pancreaticoduodenectomy