TY - JOUR
T1 - In-hospital survival after pancreatoduodenectomy is greater in high-volume hospitals versus lower-volume hospitals
T2 - a meta-analysis
AU - Kovoor, Joshua G.
AU - Ma, Ning
AU - Tivey, David R.
AU - Vandepeer, Meegan
AU - Jacobsen, Jonathan Henry W.
AU - Scarfe, Anje
AU - Vreugdenburg, Thomas D.
AU - Stretton, Brandon
AU - Edwards, Suzanne
AU - Babidge, Wendy J.
AU - Anthony, Adrian A.
AU - Padbury, Robert T. A.
AU - Maddern, Guy J.
PY - 2022/1
Y1 - 2022/1
N2 - Background: Variation in cut-off values for what is considered a high volume (HV) hospital has made assessments of volume-outcome relationships for pancreaticoduodenectomy (PD) challenging. Accordingly, we performed a systematic review and meta-analysis comparing in-hospital mortality after PD in hospitals above and below HV thresholds of various cut-off values. Method: PubMed/MEDLINE, Embase and Cochrane Library were searched to 4 January 2021 for studies comparing in-hospital mortality after PD in hospitals above and below defined HV thresholds. After data extraction, risk of bias was assessed using the Downs and Black checklist. A random-effects model was used for meta-analysis, including meta-regressions. Registration: PROSPERO, CRD42021224432. Results: From 1855 records, 17 observational studies of moderate quality were included. Median HV cut-off was 25 PDs/year (IQR: 20–32). Overall relative risk of in-hospital mortality was 0.37 (95% CI: 0.30, 0.45), that is, 63% less in HV hospitals. All subgroup analyses found an in-hospital survival benefit in performing PDs at HV hospitals. Meta-regressions from included studies found no statistically significant associations between relative risk of in-hospital mortality and region (USA vs. non-USA; p = 0.396); or 25th percentile (p = 0.231), median (p = 0.822) or 75th percentile (p = 0.469) HV cut-off values. Significant inverse relationships were found between PD hospital volume and other outcomes. Conclusion: In-hospital survival was significantly greater for patients undergoing PDs at HV hospitals, regardless of HV cut-off value or region. Future research is required to investigate regions where low-volume centres have specialized PD infrastructure and the potential impact on mortality.
AB - Background: Variation in cut-off values for what is considered a high volume (HV) hospital has made assessments of volume-outcome relationships for pancreaticoduodenectomy (PD) challenging. Accordingly, we performed a systematic review and meta-analysis comparing in-hospital mortality after PD in hospitals above and below HV thresholds of various cut-off values. Method: PubMed/MEDLINE, Embase and Cochrane Library were searched to 4 January 2021 for studies comparing in-hospital mortality after PD in hospitals above and below defined HV thresholds. After data extraction, risk of bias was assessed using the Downs and Black checklist. A random-effects model was used for meta-analysis, including meta-regressions. Registration: PROSPERO, CRD42021224432. Results: From 1855 records, 17 observational studies of moderate quality were included. Median HV cut-off was 25 PDs/year (IQR: 20–32). Overall relative risk of in-hospital mortality was 0.37 (95% CI: 0.30, 0.45), that is, 63% less in HV hospitals. All subgroup analyses found an in-hospital survival benefit in performing PDs at HV hospitals. Meta-regressions from included studies found no statistically significant associations between relative risk of in-hospital mortality and region (USA vs. non-USA; p = 0.396); or 25th percentile (p = 0.231), median (p = 0.822) or 75th percentile (p = 0.469) HV cut-off values. Significant inverse relationships were found between PD hospital volume and other outcomes. Conclusion: In-hospital survival was significantly greater for patients undergoing PDs at HV hospitals, regardless of HV cut-off value or region. Future research is required to investigate regions where low-volume centres have specialized PD infrastructure and the potential impact on mortality.
KW - centralisation
KW - pancreatoduodenectomy
KW - postoperative mortality
KW - volume-outcome relationships
KW - Whipple procedure
UR - http://www.scopus.com/inward/record.url?scp=85117458724&partnerID=8YFLogxK
U2 - 10.1111/ans.17293
DO - 10.1111/ans.17293
M3 - Article
C2 - 34676647
AN - SCOPUS:85117458724
SN - 1445-1433
VL - 92
SP - 77
EP - 85
JO - ANZ Journal of Surgery
JF - ANZ Journal of Surgery
IS - 1-2
ER -