Abstracts
1999 Digestive Disease Week

# 2132 IN HOSPITAL MORTALITY IN SMALL HOSPITAL VOLUMES CHANGE THE SURGICAL MANAGEMENT OF PANCREATIC CANCER.
Dirk J Gouma, Rutger C I van Geenen, Thomas M van Gulik, Laurens Th de Wit, Hugo Obertop, Acad Med Ctr, Amsterdam Netherlands

Previous studies from the USA have shown that postoperative mortality after pancreatoduodenectomy was significantly lower in "high volume" hospitals. This phenomenon has also been reported in the Netherlands (1994-1995). Therefore the aim of the present studiy was to analyse if surgical management of pancreatic carcinoma in small volume hospitals has changed and also reduced the overall mortality. Methods: Data on postoperative mortality after pancreatoduodenectomy (ICD-9 code 5-526, International Classifiction of Diseases) in 1996 and 1997 in the Netherlands supplied by the National Medical Register(NMR), were retrospectively analysed and compared with previous data ('94-'95). The NMR registers primary and secondary diagnosis and interventions of patients admitted to all hospitals in the Netherlands. A subanalysis was performed to asses the influence of hospital volume on mortality. Result: In 1996 and 1997 respectively 224 and 217 (total 441) pancreatoduodenectomies were performed. The overall in hospital mortality was 10,7% and is not different compared to 1994-1995 (11%). Forty-four percent of the resections were performed in small volume hospitals ('94-'95;46%). In small volume hospitals the mortality remained high (10,7%) compared to 1% in the high volume centers (p<0,05). In the previous series ('94-'95) mortality was respectively 16% and 1,5%. Conclusion: Overall hospital mortality after pancreatoduodenectomy remained high in low volume hospitals. The evidence from previous studie on improved outcome in high volume hospitals did not lead to change in referral pattern or in overall hospital mortality in the Netherlands

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