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Title of Journal: J Gastrointest Surg

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Abbravation: Journal of Gastrointestinal Surgery

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Outcomes Improvement Is Not Continuous Along the Learning Curve for Pancreaticoduodenectomy at the Hospital Level

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
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Most studies on learning curves for pancreaticoduodenectomy have been based on single-surgeon series at tertiary academic centers or are inferred indirectly from volume-outcome relationships. Our aim is to describe mortality rates associated with cumulative surgical experience among non-teaching hospitals.Observational 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 (e.g., first 10 cases, 11th through 20th cases) were identified across hospitals. The outcome measure was in-hospital mortality.A total of 1210 cases from 143 non-teaching hospitals were analyzed. The average age was 63 years old, and the majority of patients were non-Hispanic white. The median overall mortality rate was 9.75 %. The mortality rate for the first 10 aggregated cases was 11.3 %. This improved for subsequent cases, reaching 7.1 % for the 21st–30th cases. However, the mortality rate then increased, reaching 16.7 % by the 41st–50th cases before falling to 0.0 % by the 61st–70th cases.Initial 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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Other Papers In This Journal:

  1. Is there a Role for Surgery with Adequate Nodal Evaluation Alone in Gastric Adenocarcinoma?
  2. Outcomes Improvement Is Not Continuous Along the Learning Curve for Pancreaticoduodenectomy at the Hospital Level
  3. Small Intestinal Submucosa as a Bioscaffold for Tissue Regeneration in Defects of the Colonic Wall
  4. Prognostic Factors and 10-Year Survival in Patients with Hepatocellular Carcinoma After Curative Hepatectomy
  5. Reduction of the Incidence of Delayed Gastric Emptying in Side-to-Side Gastrojejunostomy in Subtotal Stomach-Preserving Pancreaticoduodenectomy
  6. Surgeon Volume is Predictive of 5-Year Survival in Patients with Hepatocellular Carcinoma after Resection: A Population-Based Study
  7. Superior Mesenteric Artery Syndrome: Diagnosis and Treatment Strategies
  8. Choledochal Cysts: Differences Between Pediatric and Adult Patients
  9. Metastatic Melanoma Causing Jejunal Intussusception
  10. Giant Splenic Artery Pseudoaneurysm
  11. Impact of Resection for Primary Colorectal Cancer on Outcomes in Patients with Synchronous Colorectal Liver Metastases
  12. How I Do It: Laparoscopic Paraesophageal Hernia Repair
  13. Clinicopathologic Features of Gastric Carcinoma with Signet Ring Cell Histology
  14. High-Resolution Manometry Classifications for Idiopathic Achalasia in Patients with Chagas' Disease Esophagopathy
  15. Transnasal Fine Gastrointestinal Fiberscope-guided Long Tube Insertion for Patients with Small Bowel Obstruction
  16. Pancreaticogastrostomy Versus Pancreaticojejunostomy After Pancreaticoduodenectomy: a Systematic Review and Meta-Analysis of Randomized Controlled Trials
  17. Extracorporeal Hypothermic Perfusion Device for Intestinal Graft Preservation to Decrease Ischemic Injury During Transportation
  18. A Nationwide Analysis of Changes in Severity and Outcomes of Inflammatory Bowel Disease Hospitalizations
  19. Perioperative Complications After Neoadjuvant Chemotherapy With and Without Bevacizumab for Colorectal Liver Metastases
  20. Pharmacological management to prevent ileus in major abdominal surgery: a systematic review and meta-analysis

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