title: Management and Outcomes of Pancreatic Resections Performed in High-Volume Referral and Low-Volume Community Hospitals Lead by Surgeons Who Shared the Same Mentor: The Importance of Training.
abstract: BACKGROUND
  High hospital volume improves outcomes after pancreatic resection. The aim of this study was to assess if practice and outcomes differed between high- and low-volume centers across which chief surgeons shared a similar training and mentoring.
  
  
  METHODS
  Data on patients undergoing standard pancreatic resections (2010-2013) at 7 Italian hospitals were collected. Chiefs of pancreatic surgery at each hospital had received the same training, with the same mentor. Two centers were high-volume referral hospitals for pancreatic disease, while 5 were low-volume hospitals.
  
  
  RESULTS
  A total of 856 patients were included, with median annual volume of resections 82 at high-volume referral hospitals and 11 at low-volume hospitals. Patients at low-volume hospitals were older, had more comorbidities, and were more often referred from the emergency room. Intraoperative techniques and reconstruction methods were similar. Comparable rates of major postoperative complications (18 vs. 22%; p = 0.236) and pancreatic fistula (29 vs. 32%; p = 0.287) were achieved in both groups, with no significant increases in failure to rescue from grade B-C fistula (6.2 vs. 15.0%; p = 0.108) and mortality (2.4 vs. 4.1%; p = 0.233) in low-volume hospitals. Postoperative length of stay was shorter in high-volume referral hospitals (10 vs. 15 days; p < 0.001).
  
  
  CONCLUSIONS
  Similar postoperative outcomes can be achieved across high- and low-volume centers where chief surgeons shared a similar training and mentoring. However, multidisciplinary postoperative provision more often associated with high-volume centers may also affect outcomes.
authors.affiliation: Ospedale San Carlo Borromeo, Milano, Italy.
authors.forename: Giovanni
authors.initials: G
authors.lastname: Capretti
authors.forename: Gianpaolo
authors.initials: G
authors.lastname: Balzano
authors.forename: Luca
authors.initials: L
authors.lastname: Gianotti
authors.forename: Marco
authors.initials: M
authors.lastname: Stella
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ferrari
authors.forename: Paolo
authors.initials: P
authors.lastname: Baccari
authors.forename: Walter
authors.initials: W
authors.lastname: Zuliani
authors.forename: Marco
authors.initials: M
authors.lastname: Braga
authors.forename: Alessandro
authors.initials: A
authors.lastname: Zerbi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006764:Hospitals, Community; D061847:Hospitals, High-Volume; D061846:Hospitals, Low-Volume; D006801:Humans; D007558:Italy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008611:Mentors; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D010180:Pancreatectomy / Q000193:education*; D016577:Pancreaticoduodenectomy / Q000193:education*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D066231:Surgeons / Q000193:education*
keywords: Outcomes; Pancreatic surgery; Surgeon; Training; Volume