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Introduction:
The Leapfrog Group has stated that outcomes after high-risk procedures, like pancreaticoduodenectomy, are superior at high-volume hospitals. High-volume hospitals are inexorably intertwined to high-volume surgeons; however, high-volume hospitals also have low-volume surgeons. This study was undertaken to determine if outcomes after pancreaticoduodenectomy are different for high-volume vs. low-volume surgeons at high-volume hospitals.

Methods:
High-volume hospitals for pancreaticoduodenectomy (defined by the Leapfrog Group as ≥ 12/year) were identified from the State of Florida Agency for Health Care Administration database for a 33-month period ending in October 2010. In these centers, outcomes for high-volume surgeons (undertaking ≥ 12 pancraetoduodenectomies per year) were compared to those of low-volume surgeons (undertaking < 12 pancraetoduodenectomies per year). Median data are presented.

Results:
55 surgeons undertook 928 pancreaticoduodenectomies at 6 high-volume hospitals; 10 surgeons were high-volume surgeons. High-volume surgeons in these high-volume hospitals had shorter lengths of stay (LOS), lower in-hospital mortality, and lower hospital costs (p<0.001) than low-volume surgeons (Table).

Conclusions:
Within high-volume hospitals, high-volume surgeons have superior outcomes (including decreased lengths of stay, in-hospital mortality, and cost of care) relative to low-volume surgeons. Outcomes after pancreatecticoduodenectomy at high-volume hospitals are dependent upon surgeon volume; any “hospital affect” is limited and does not benefit low-volume surgeons.

	# of Surgeons	# of PD's	LOS (days)	In-Hospital Mortality	Hospital Charge (\0
High-Volume Hospitals	55	928	11 (15 ± 14)	4.09%	99,409 ( \,578 ± 153,064)
High-Volume Surgeons	10	705	10 (15 ± 14)	2.83%	98,848 ( \,218 ± 136,379)
Low-Volume Surgeons	45	223	12 (17 ± 14)*	8.07%*	100,289 ( \,166 ± 194,142)*

*p<0.01 vs. High-Volume Surgeons