Ninety day mortality following pancreatoduodenectomy in England: has the optimum centre volume been identified?

Z. Liu; I. S. Peneva; F. Evison; S. Sahdra; D. F. Mirza; R. M. Charnley; R. Savage; P. A. Moss; K. J. Roberts

doi:10.1016/j.hpb.2018.04.008

Ninety day mortality following pancreatoduodenectomy in England: has the optimum centre volume been identified?

Z. Liu, I. S. Peneva, F. Evison, S. Sahdra, D. F. Mirza, R. M. Charnley, R. Savage, P. A. Moss, K. J. Roberts

Research output: Contribution to journal › Article › peer-review

6 Citations (Scopus)

Abstract

BACKGROUND: Mortality following pancreatoduodenectomy is related to centre volume although the optimal volume is not defined.

METHODS: Patients undergoing PD between 2001 and 2016 were identified from UK national databases. The effects of patient variables, centre volume and time period upon 90 day mortality were studied.

RESULTS: 90 day mortality (970/14,935, 6.5%) was related to advanced age, comorbidity, diagnosis, ethnicity, deprivation, centre volume and time period. Mortality rates fell markedly from 10.0% in 2001-4 to 4.1% in 2013-16. There was no difference in 90 day mortality between high (36 -60 PD per year) and very high volume (>60) centres. However, patients operated upon at very high volume centres were more elderly (66, 58 -73 vs 65, 56 -72; median, IQR; p = 0.006), deprived (38.7 vs 34.6%; p < 0.001) and co morbid (48.9 vs 46.1%; p = 0.027).

CONCLUSION: Although a plateau in the centre volume and mortality relationship appears to have been demonstrated those patients treated at the highest volume centres were at higher risk of mortality. This data suggests therefore that to further understand outcomes from specialist centres characteristics of the patient population should be defined, not just centre volume.

Original language	English
Journal	HPB : the official journal of the International Hepato Pancreato Biliary Association
Early online date	9 Jun 2018
DOIs	https://doi.org/10.1016/j.hpb.2018.04.008
Publication status	E-pub ahead of print - 9 Jun 2018

Access to Document

10.1016/j.hpb.2018.04.008Licence: None: All rights reserved

https://www.sciencedirect.com/science/article/pii/S1365182X18308116Licence: None: All rights reserved

Cite this

Liu, Z., Peneva, I. S., Evison, F., Sahdra, S., Mirza, D. F., Charnley, R. M., Savage, R., Moss, P. A., & Roberts, K. J. (2018). Ninety day mortality following pancreatoduodenectomy in England: has the optimum centre volume been identified? HPB : the official journal of the International Hepato Pancreato Biliary Association. Advance online publication. https://doi.org/10.1016/j.hpb.2018.04.008

@article{4ac26bd85c4d4047bab2151c4d466dec,

title = "Ninety day mortality following pancreatoduodenectomy in England: has the optimum centre volume been identified?",

abstract = "BACKGROUND: Mortality following pancreatoduodenectomy is related to centre volume although the optimal volume is not defined.METHODS: Patients undergoing PD between 2001 and 2016 were identified from UK national databases. The effects of patient variables, centre volume and time period upon 90 day mortality were studied.RESULTS: 90 day mortality (970/14,935, 6.5%) was related to advanced age, comorbidity, diagnosis, ethnicity, deprivation, centre volume and time period. Mortality rates fell markedly from 10.0% in 2001-4 to 4.1% in 2013-16. There was no difference in 90 day mortality between high (36 -60 PD per year) and very high volume (>60) centres. However, patients operated upon at very high volume centres were more elderly (66, 58 -73 vs 65, 56 -72; median, IQR; p = 0.006), deprived (38.7 vs 34.6%; p < 0.001) and co morbid (48.9 vs 46.1%; p = 0.027).CONCLUSION: Although a plateau in the centre volume and mortality relationship appears to have been demonstrated those patients treated at the highest volume centres were at higher risk of mortality. This data suggests therefore that to further understand outcomes from specialist centres characteristics of the patient population should be defined, not just centre volume.",

author = "Z. Liu and Peneva, {I. S.} and F. Evison and S. Sahdra and Mirza, {D. F.} and Charnley, {R. M.} and R. Savage and Moss, {P. A.} and Roberts, {K. J.}",

note = "Copyright {\textcopyright} 2018. Published by Elsevier Ltd.",

year = "2018",

month = jun,

day = "9",

doi = "10.1016/j.hpb.2018.04.008",

language = "English",

journal = "HPB : the official journal of the International Hepato Pancreato Biliary Association",

issn = "1365-182X",

publisher = "Wiley",

}

TY - JOUR

T1 - Ninety day mortality following pancreatoduodenectomy in England

T2 - has the optimum centre volume been identified?

AU - Liu, Z.

AU - Peneva, I. S.

AU - Evison, F.

AU - Sahdra, S.

AU - Mirza, D. F.

AU - Charnley, R. M.

AU - Savage, R.

AU - Moss, P. A.

AU - Roberts, K. J.

PY - 2018/6/9

Y1 - 2018/6/9

N2 - BACKGROUND: Mortality following pancreatoduodenectomy is related to centre volume although the optimal volume is not defined.METHODS: Patients undergoing PD between 2001 and 2016 were identified from UK national databases. The effects of patient variables, centre volume and time period upon 90 day mortality were studied.RESULTS: 90 day mortality (970/14,935, 6.5%) was related to advanced age, comorbidity, diagnosis, ethnicity, deprivation, centre volume and time period. Mortality rates fell markedly from 10.0% in 2001-4 to 4.1% in 2013-16. There was no difference in 90 day mortality between high (36 -60 PD per year) and very high volume (>60) centres. However, patients operated upon at very high volume centres were more elderly (66, 58 -73 vs 65, 56 -72; median, IQR; p = 0.006), deprived (38.7 vs 34.6%; p < 0.001) and co morbid (48.9 vs 46.1%; p = 0.027).CONCLUSION: Although a plateau in the centre volume and mortality relationship appears to have been demonstrated those patients treated at the highest volume centres were at higher risk of mortality. This data suggests therefore that to further understand outcomes from specialist centres characteristics of the patient population should be defined, not just centre volume.

AB - BACKGROUND: Mortality following pancreatoduodenectomy is related to centre volume although the optimal volume is not defined.METHODS: Patients undergoing PD between 2001 and 2016 were identified from UK national databases. The effects of patient variables, centre volume and time period upon 90 day mortality were studied.RESULTS: 90 day mortality (970/14,935, 6.5%) was related to advanced age, comorbidity, diagnosis, ethnicity, deprivation, centre volume and time period. Mortality rates fell markedly from 10.0% in 2001-4 to 4.1% in 2013-16. There was no difference in 90 day mortality between high (36 -60 PD per year) and very high volume (>60) centres. However, patients operated upon at very high volume centres were more elderly (66, 58 -73 vs 65, 56 -72; median, IQR; p = 0.006), deprived (38.7 vs 34.6%; p < 0.001) and co morbid (48.9 vs 46.1%; p = 0.027).CONCLUSION: Although a plateau in the centre volume and mortality relationship appears to have been demonstrated those patients treated at the highest volume centres were at higher risk of mortality. This data suggests therefore that to further understand outcomes from specialist centres characteristics of the patient population should be defined, not just centre volume.

U2 - 10.1016/j.hpb.2018.04.008

DO - 10.1016/j.hpb.2018.04.008

M3 - Article

C2 - 29895441

SN - 1365-182X

JO - HPB : the official journal of the International Hepato Pancreato Biliary Association

JF - HPB : the official journal of the International Hepato Pancreato Biliary Association

ER -

Ninety day mortality following pancreatoduodenectomy in England: has the optimum centre volume been identified?

Abstract

Access to Document

Fingerprint

Cite this