Rates of complications and death after pancreaticoduodenectomy: Risk factors and the impact of hospital volume

Objective To perform a two-part study of pancreaticoduodenectomy in the Netherlands, focusing on the effects of risk factors on outcomes in a single high-volume hospital and the effect of hospital volume on outcomes. Summary Background Data Hospital volume and surgeon caseload can be related to the rates of complic ations and death, and the influence of risk factors can be volume-dependent . Provision of regionalized care should take this into account. Methods In part A, a single-institution database on 300 consecutive patients underg oing pancreaticoduodenectomy was divided into two periods with similar numb ers of patients. Overall complications, deaths, hospital stay, and risk fac tors were analyzed in the two periods and compared with an historical refer ence group. In part B, Netherlands medical registry data on age and postope rative death of patients who underwent partial pancreaticoduodenectomy from 1994 to 1998 were analyzed for the influence of hospital volume on death. Results Between the time periods, the institutional death rate decreased from 4.9% to 0.7%, the complication rate from 60% to 41%. Median hospital stay decrea sed from 24 to 15 days. The death rate was not related to patient age and d id not differ between surgeons. Serum creatinine levels, need for blood tra nsfusion, and period of resection were independent risk factors for complic ations. The death rate after pancreaticoduodenectomy in the Netherlands was 12.6% i n 1994 and 10.1% in 1998; it was greater in patients older than age 65. Dur ing the 5-year period, 40% of the procedures were performed in hospitals pe rforming fewer than five resections per year. and the death rate was greate r than in hospitals performing more than 25 resections per year. Conclusions The overall death rate after pancreaticoduodenectomy did not decrease signi ficantly during the period, and it was greater in low-volume hospitals and older patients. The lower death and complication rates in high-volume hospi tals, including the single-center outcomes, were similar to those reported in other countries and may be due to better prevention and management of co mplications. Pancreaticoduodenectomy should be performed in centers with su fficient experience and resources for support.