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High Volume Hospitals With High- and Low-Volume Surgeons: Is There a ‘Field Effect' for Pancreaticoduodenectomy?
Thomas W. Wood*, Sharona B. Ross, Amanda E. Smart, Carrie E. Ryan, Prashant Sukharamwala, Alexander S. Rosemurgy
Southeastern Center for Digestive Disorders and Pancreatic Cancer, Florida Hospital Tampa, Tampa, FL
Introduction: Since the Leapfrog Group established criteria for hospital volume for pancreaticoduodenectomy, the importance of surgeon volume over hospital volume in obtaining superior outcomes has been debated. This study was undertaken to determine if, in high-volume hospitals, low-volume surgeons attain the same outcomes as high-volume surgeons.
Methods: The data for pancreaticoduodenectomy in Florida during 2010-2012 were obtained from the Florida Agency for Health Care Administration. High-volume hospitals were identified and surgeon volumes within were determined; postoperative length of stay (LOS), in-hospital mortality, discharge status, and hospital charges (adjusted to 2012 dollars) were examined relative to surgeon volume.
Results: Six high-volume hospitals were identified to have at least one surgeon who undertook ≥ 12 pancreaticoduodenectomies per year and at least one surgeon who undertook < 12 per year. At these hospitals during 2010-2012, there were 10 ‘high-volume' surgeons who undertook 714 pancreaticoduodenectomies, an average of 24 pancreaticoduodenectomies per surgeon per year, and 33 ‘low-volume' surgeons who undertook 225 pancreaticoduodenectomies, an average of 2 pancreaticoduodenectomies per surgeon per year. The frequency with which surgeons undertook pancreaticoduodenectomy did not predict LOS, in-hospital mortality, discharge status, or hospital charges.
Discussion: At high-volume hospitals from 2010 to 2012, low-volume surgeons did not have different outcomes from the high-volume surgeons with respect to patient LOS, in-hospital mortality, percentage of patients discharged home, or hospital charges. While the discussion of volume for complex operations has shifted toward surgeon volume, hospital volume must remain part of the discussion as there appears to be a significant, though intangible, hospital ‘field effect'.
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