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Assessing the Interplay of Operative Volume at the Hospital and Surgeon Level for Pancreatic Cancer
Journal article   Peer reviewed

Assessing the Interplay of Operative Volume at the Hospital and Surgeon Level for Pancreatic Cancer

Dhruv J. Patel, Joseph H. Cotler, Bryan Palis, Anthony D. Yang, C. Max Schmidt, Ronald J. Weigel, Karl Y. Bilimoria and Ryan J. Ellis
HPB (Oxford, England)
07/14/2026
DOI: 10.1016/j.hpb.2026.07.007

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Abstract

The current retrospective study aimed to assess the interaction between surgeon-volume and hospital-volume on outcomes after pancreatoduodenectomy (PD) for pancreatic ductal adenocarcinoma (PDAC). Patients with PDAC undergoing PD from 2008 to 2023 were identified using the National Cancer Database. Operative volumes of ≥20 cases/year defined high-volume hospitals (HVH) and ≥12 cases/year defined high-volume surgeons (HVS). Those below those thresholds were low-volume surgeons (LVS) and low-volume hospitals (LVH). Multivariable logistic regression was used to assess associations between surgeon/hospital volume and outcomes, relative to HVS/HVH. The inclusion cohort consisted of 50,519 patients treated by 3,155 surgeons operating at 976 hospitals. 90-day mortality declined with increasing volume: LVS/LVH = 6.4%, HVS/LVH = 5.7%, LVS/HVH = 4.0%, HVS/HVH = 3.5% (p<0.001). Patients undergoing surgery by HVS/LVH [Odds Ratio (OR): 1.58, 95% Confidence Interval (95%CI): (1.12, 2.24), p=0.009] and LVS/LVH [OR: 1.59, 95%CI: (1.24, 2.04), p<0.001] had a higher adjusted likelihood of mortality. LVS/HVH was not associated with mortality compared with HVS/HVH. Both HVS/LVH [OR: 1.93, 95%CI: (1.27, 2.92), p=0.002] and LVS/LVH [OR: 1.60, 95% CI: (1.15, 2.23), p=0.006] had a higher likelihood of readmission. Outcomes after PD for PDAC remain more greatly influenced by hospital-volume rather than surgeon-volume.
 Pancreas hospital pancreatoduodenectomy surgeon volume-outcome

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