Presence of a fellowship improves perioperative outcomes following hepatopancreatobiliary procedures.
There is an increase in subspecialization and in the number of surgeons seeking fellowship training in the USA. Little is known regarding the effect of hepatopancreatobiliary (HPB) fellowship programs' status of an institution on perioperative outcomes. This study aims to examine the effect of such status on perioperative outcomes across all institutions following complex surgeries involving HPB procedures in the State of New York (NYS).



The Statewide Planning and Research Cooperative System administrative database was used to identify several complex surgeries involving the pancreas, liver, and gallbladder by using ICD-9 codes for inpatient procedures between 2012 and 2014. Procedures were compared in terms of 30-day readmission, hospital length of stay (HLOS), and major complications between institutions with and without fellowship. Linear mixed model and generalized linear mixed models were used to compare the differences.



There were 4156 procedures identified during 2012-2014 in NYS. Among these, 1685 (40.5%) were pancreatic surgeries only, 1031 (24.8%) were liver surgeries only, 1288 (31.0%) were gallbladder surgeries only, 11 (0.3%) were both pancreatic and liver surgeries, 124 (3.0%) were both liver and gallbladder, and 17 (0.4%) were both pancreatic and gallbladder. Elderly patients tended to go to the hospitals with HPB fellowship. Following multivariable regression and controlling for other factors, hospitals with fellowships remained significantly associated with less severe complications (OR 0.49, 95% CI 0.29-0.83, p = 0.0075). No significant differences were seen between hospitals with and without fellowship in terms of 30-day readmissions (p = 0.6) and HLOS (p = 0.4).



Institutions offering HPB fellowship training were associated with significantly improved rate of complications, although there was no significant difference in terms of 30-day readmission rate or HLOS. This data highlight the importance of a presence of a fellowship in complex hepatopancreatobiliary procedures.
Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, NY, 11794, USA. maria.altieri@stonybrookmedicine.edu.
Maria S
MS
Altieri
Department of Family, Population and Preventive Medicine, Stony Brook University Medical Center, Stony Brook, NY, USA.
Jie
J
Yang
Department of Applied Mathematics and Statistics, Stony Brook University, Stony Brook, NY, USA.
Donglei
D
Yin
Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, NY, 11794, USA.
Catherine
C
Frenkel
Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, NY, 11794, USA.
Mark
M
Talamini
Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, NY, 11794, USA.
Dana A
DA
Telem
Division of Bariatric, Foregut and Advanced Gastrointestinal Surgery, Department of Surgery, Stony Brook University Medical Center, 100 Nichols Road, HSC T18-040, Stony Brook, NY, 11794, USA.
Aurora
A
Pryor
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D013505:Digestive System Surgical Procedures / Q000193:education* / Q000592:standards / Q000706:statistics & numerical data; D004503:Education, Medical, Graduate; D005257:Fellowships and Scholarships; D005260:Female; D005704:Gallbladder / Q000601:surgery*; D006801:Humans; D016014:Linear Models; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009518:New York; D017063:Outcome Assessment, Health Care; D010179:Pancreas / Q000601:surgery*; D010359:Patient Readmission / Q000706:statistics & numerical data; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D019984:Quality Indicators, Health Care / Q000706:statistics & numerical data; D055815:Young Adult
Fellowship; Hepatopancreaticobiliary; Outcomes