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Trends and Disparities in Regionalization of Pancreatic Resection
Taylor S. Riall*1, Courtney M. Townsend1, Jean L. Freeman2, William H. Nealon1
1Surgery, University of Texas Medical Branch, Galveston, TX; 2Internal Medicine, University of Texas Medical Branch, Galveston, TX

Background: It has been demonstrated that centers performing high volumes of pancreatic resection have lower mortality rates and improved long-term outcomes. This has led the Leapfrog group (a consortium of employers with the goal of improving health care quality and safety) to initiate evidence-based hospital referral parameters for pancreatic resection, recommending that pancreatic resections be performed at hospitals doing more than ten pancreatic resections annually.
Objective: To evaluate the extent of regionalization of pancreatic resection and the factors predicting resection at a high-volume center (>10 cases/year) in the state of Texas.
Methods: Using the Texas Hospital Inpatient Discharge Public Use Data File we will evaluate trends in the percentage of patients undergoing pancreatic resection for all causes at high-volume centers (>10 cases/year) over the time period 1999-2004. Using univariate and multivariate models we will determine the factors that predict resection at high-volume centers.
Results: In the six year time period, 3,537 pancreatic resections were performed in the state of Texas. The unadjusted mortality was higher at low-volume centers (7.63%) when compared to high-volume centers (2.95%). The percentage of patients resected at high-volume centers increased from 57.5% in 1999 to 65.2% in 2004 (P=0.0014 for trend). This was the result of a decrease in resections performed at centers doing <5 resections/year (33.2% to 24.7%) and a concomitant increase in centers performing greater than 20 resections/year (37.5% to 44.3%). In a logistic regression analysis, the year of diagnosis was an independent predictor of resection at a high-volume center, with a 7% increase in likelihood per advancing year. Patients who were older, black, Hispanic, and had a higher mortality risk were less likely to be resected at high volume centers.
Conclusions: While regionalization of pancreatic resection at high-volume centers in the state of Texas has improved slightly over time, 35% of patients continue to undergo pancreatic resection at low-volume centers with 25% of these occurring at centers doing < 5/year. There are obvious demographic disparities in the regionalization of care but additional unmeasured barriers need to be identified.

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