Authors: Taylor M Coe Zhi Ven Fong Samuel E Wilson Mark A Talamini Keith D Lillemoe David C Chang
Publish Date: 2015/10/05
Volume: 19, Issue: 12, Pages: 2132-2137
Abstract
Most studies on learning curves for pancreaticoduodenectomy have been based on singlesurgeon series at tertiary academic centers or are inferred indirectly from volumeoutcome relationships Our aim is to describe mortality rates associated with cumulative surgical experience among nonteaching hospitalsObservational study of a statewide inpatient database Analysis included hospitals that began performing pancreaticoduodenectomy between 1996 and 2010 as captured by the California Office of Statewide Health Planning and Development database Cases were numbered sequentially within each hospital The same sequential series eg first 10 cases 11th through 20th cases were identified across hospitals The outcome measure was inhospital mortalityA total of 1210 cases from 143 nonteaching hospitals were analyzed The average age was 63 years old and the majority of patients were nonHispanic white The median overall mortality rate was 975 The mortality rate for the first 10 aggregated cases was 113 This improved for subsequent cases reaching 71 for the 21st–30th cases However the mortality rate then increased reaching 167 by the 41st–50th cases before falling to 00 by the 61st–70th casesInitial improvement in surgical outcomes relative to cumulative surgical experience is not sustained It is likely that factors other than surgical experience affect outcomes such as less rigorous assessment of comorbidities or changes in support services Vigilance regarding outcomes should be maintained even after initial improvements
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