Abstract
Survival Impact and Disparities in Access for High Volume Pancreatic Surgery
Journal of the American College of Surgeons, Vol.221(4), pp.S94-S94
10/2015
DOI: 10.1016/j.jamcollsurg.2015.07.216
Abstract
Introduction
This study looked to characterize the impact of hospital and physician pancreatic surgery volume on postoperative outcomes, survival, and health care costs. We also investigated sociodemographic variables associated with access to high volume providers.
Methods
The Nationwide Inpatient Sample (NIS) was used to identify patients who underwent pancreatic surgery between 2003 and 2009. Demographics, socioeconomic status, and racial risk factors were evaluated. Logistic regression models were used to evaluate complication rates related to pancreatectomies.
Results
Of the 16,792 patients included, 48% of pancreatectomies were performed for malignant pancreatic disease and 29.9% for benign pancreatic conditions. Postoperative complications were highest in older patients (95% CI, 0.87,1.56, p=0.013), Medicare-insured (95% CI, 1.18,1.61, p<0.001), and patients treated by low volume surgeons (LVS) (95% CI, 1.19,1.69, p<0.001) and at low volume hospitals (LVH) (95% CI, 1.19,1.78, p<0.001). Mortality risk was higher in patients with Medicare insurance (p<0.001) and those treated by LVS and in LVH (p=0.008 and p<0.001, respectively). The average cost of health services per case was found to be higher for patients managed by LVS and LVH compared with their high volume counterparts ($45,496.00±$1,324.50 vs $36,912.00±$1,257.40, p<0.001 and $43,747.00±$887.81 vs $39,622.00±$1,298.71, p=0.008, respectively).
Conclusions
Treatment at LVH and by LVS is associated with worse postoperative outcomes for patients undergoing pancreatic surgery. Insurance and race may be important determinants of volume-based care. Addressing the causes for these findings is important to decrease health care costs and ensure all patients undergoing pancreatectomies receive access to high quality care.
Details
- Title: Subtitle
- Survival Impact and Disparities in Access for High Volume Pancreatic Surgery
- Creators
- Lauren Pointer - Tulane UniversityZaid Al-QurayshiEmad Kandil - Tulane UniversityDouglas P. Slakey - Tulane University
- Resource Type
- Abstract
- Publication Details
- Journal of the American College of Surgeons, Vol.221(4), pp.S94-S94
- Publisher
- ELSEVIER SCIENCE INC
- DOI
- 10.1016/j.jamcollsurg.2015.07.216
- ISSN
- 1072-7515
- eISSN
- 1879-1190
- Language
- English
- Date published
- 10/2015
- Academic Unit
- Otolaryngology
- Record Identifier
- 9984702774602771
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