TAKING A STRATEGIC PAGE FROM THE ACADEMIC POWERS - REGIONALIZATION OF PANCREATIC CANCER CARE
Katherine Stern*2, Austin L. Spitzer1,2, CK Chang1, Kourosh Kojouri1, Purvi Parikh1
1General and HPB Surgery, Kaiser Permanente, Oakland, CA; 2UCSF - East Bay, Oakland, CA
Background: Pancreatic cancer (PDAC) is a dismal systemic malignancy with stagnant cure rate. Fortunately, patient selection has become increasingly objective and operative mortality in high volume medical centers has declined to less than 5%. Major academic centers have repeatedly demonstrated the value of high volume surgeon(s) and their respective centers in optimizing the care and outcomes of individuals undergoing surgery for PDAC. We hypothesized that by centralizing PDAC care within a large integrated health care system we could similarly optimize the care and outcomes of these uniquely complicated individuals.
Methods: All individuals undergoing pancreaticoduodenectomy (PD) in the Northern California (NCAL) integrated health care system's Hepatico-Pancreatico-Biliary (HPB) service from 2012 to 2019 were retrospectively evaluated. Four dedicated HPB centers were created from 21 hospitals throughout NCAL based on minimizing geographic burden and promoting patient directed care pathways. All four NCAL HPB centers were staffed with an ensemble team of fellowship trained HPB surgeons, interventional radiologists, advanced gastroenterologists, medical and radiation oncologists, and nutrition specialists. Continuous best practice(s) and objective and transparent data review were performed on a quarterly basis with all four HPB centers represented and critiqued.
Results: All PD performed within NCAL HPB from 2012 to 2019 were examined for operative time (OR time), length of stay (LOS), and 90 - day mortality (90-day mortality). Regionalization resulted in a significant reduction in LOS with standardization of OR time and an appropriate 90-day mortality. Please see Table 1.
Conclusion: Centralizing pancreatic cancer through regionalization of HPB centers has resulted in significant improvement in LOS, while maintaining consistent OR time and 90-day mortality. As the academic centers have previously demonstrated, focusing expertise and resources into center(s) improves patient directed care and outcomes for PDAC. Further, our open and objective review between the 4 HPB centers has facilitated systemic change in peri-operative management and patient directed care in both surgical and oncologic disciplines. Given the volume of the large integrated health care system, regionalization of the HPB centers has decreased the travel and expenses for PDAC patients while optimizing their care.
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