Standardization and streamlining of a pancreas surgery practice improves outcomes and resource utilization: A single institution's 20-year experience.
BACKGROUND
In the past two decades, pancreas surgery (PS) has undergone significant advances in operative techniques and with a focus on multidisciplinary high-volume practices.


METHODS
A review of patients undergoing PS from 3/1995-2/2015 was conducted; dividing patients into group A (1995-2005) and group B (2005-2015) for a detailed comparison. Effect of surgeon volume in group B was determined.


RESULTS
A total of 1001 patients underwent PS (group A: 259; group B: 742). The mean age was 62.7 years and 52.8% were female. Group B patients were associated with a higher rate of pylorus preservation and minimally invasive resection and a lower rate of morbidity, pancreas fistula (PF), and delayed gastric emptying (DGE) than group A. High-volume surgeons (HVS) had lower operative blood loss (300 mL vs 600 mL), transfusion requirements, PF (14% vs 20%), DGE, surgical site infections, reoperations, and major morbidity rate (15.5 vs 39%) than low-volume surgeons.


CONCLUSIONS
This study demonstrates improved patient outcomes and hospital resource utilization over the past 20 years. Concentration of PS to HVS results in superior results.
Department of Surgery, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA. Electronic address: stauffer.john@mayo.edu.
John A
JA
Stauffer
Department of Surgery, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
Edwin O
EO
Onkendi
Department of Gastroenterology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
Michael B
MB
Wallace
Department of Gastroenterology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
Massimo
M
Raimondo
Department of Gastroenterology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
Timothy A
TA
Woodward
Department of Gastroenterology, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
Frank J
FJ
Lukens
Department of Surgery, Mayo Clinic, 4500 San Pablo Road South, Jacksonville, FL, 32224, USA.
Horacio J
HJ
Asbun
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006295:Health Resources / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data*; D010182:Pancreatic Diseases / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome
Distal pancreatectomy; High-volume; Multidisciplinary; Outcomes; Pancreas; Pancreatectomy; Pancreatoduodenectomy