Relation between hospital surgical volume and outcome for pancreatic resection for neoplasm in a publicly funded health care system

Background: Recent studies from the United States have shown that instituti ons with higher numbers of pancreatic resection procedures for neoplasm hav e lower mortality rates associated with this procedure. However, minimal wo rk has been done to assess whether the results of similar volume-outcome st udies within a publicly financed health care system would differ from those obtained in a mixed public-private health care system. Methods: A population-based retrospective analysis was used to examine panc reatic resection for neoplasm in Ontario for the period 1988/89 to 1994/95. Outcomes examined included in-hospital case fatality rate and mean length of stay in hospital. For each hospital, total procedure volume for the stud y period was defined as low (fewer than 22), medium (22-42) or high (more t han 42). Regression models were used to measure volume-outcome relations. Results: The likelihood of postoperative death was higher in low-volume and medium-volume centres than in high-volume centres (odds ratio 5.1 and 4.5 respectively; p < 0.01 for both). Mean length of stay was greater in low- a nd medium-volume centres than in high-volume centres (by 7.7 and 9.2 days r espectively, p < 0.01 for both). Interpretation: This study adds to growing evidence that, for pancreatic re section for neoplasm, patients may have better outcomes if they are treated in high-volume hospitals rather than low-volume hospitals.