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The relationship of hospital and surgeon volume indicators and post-operative outcomes in pancreatic surgery: A systematic literature review, meta-analysis and guidance for valid outcome assessment

Published:January 23, 2023DOI:https://doi.org/10.1016/j.hpb.2023.01.008

      Abstract

      Background

      Available evidence on the volume-outcome relationship after pancreatic surgery is limited due to their narrow focus of intervention, volume indicator, outcome assessment or methodological differences of the included studies. Therefore, we aim to evaluate the volume-outcome relationship following pancreatic surgery following strict study selection and quality criteria and to identify aspects of methodological variation define a set of key methodological indicators to consider when aiming for comparable and valid outcome assessment.

      Methods

      Four electronic databases were searched to identify studies on the volume-outcome relationship in pancreatic surgery published between the years 2000 to 2018. Following a double-screening process, data extraction, quality appraisal, and subgroup analysis, results of included studies were stratified and pooled using random effects meta-analysis.

      Results

      Consistent associations were found between high hospital volume and both postoperative mortality (OR 0.35, 95% CI: 0.29 – 0.44) and major complications (OR 0.87, 95% CI: 0.80-0.94). A significant decrease in the odds ratio was also found for high surgeon volume and postoperative mortality (OR 0.29, 95%CI: 0.22 – 0.37).

      Discussion

      Our meta-analysis confirms a positive effect for both hospital and surgeon volume indicators for pancreatic surgery. Further harmonization (e.g. surgery types, volume cut-offs/definition, case-mix adjustment, reported outcomes) are recommended for future empirical studies.

      Keywords

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      References

        • Luft H.S.
        • Bunker J.P.
        • Enthoven A.C.
        Should operations be regionalized? The empirical relation between surgical volume and mortality.
        N Engl J Med. 1979; 301: 1364-1369
        • Enomoto L.M.
        • Gusani N.J.
        • Dillon P.W.
        • Hollenbeak C.S.
        Impact of surgeon and hospital volume on mortality, length of stay, and cost of pancreaticoduodenectomy.
        J Gastrointest Surg. 2014; 18: 690-700
        • Mehta H.B.
        • Parmar A.D.
        • Adhikari D.
        • Tamirisa N.P.
        • Dimou F.
        • Jupiter D.
        • et al.
        Relative impact of surgeon and hospital volume on operative mortality and complications following pancreatic resection in Medicare patients.
        J Surg Res. 2016; 204: 326-334
        • Gooiker G.A.
        • Van Gijn W.
        • Wouters M.W.J.M.
        • Post P.N.
        • Van De Velde C.J.H.
        • Tollenaar R.A.E.M.
        Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery.
        British Journal of Surgery. 2011; 98: 485-494
        • Hata T.
        • Motoi F.
        • Ishida M.
        • Naitoh T.
        • Katayose Y.
        • Egawa S.
        • et al.
        Effect of Hospital Volume on Surgical Outcomes After Pancreaticoduodenectomy: A Systematic Review and Meta-analysis.
        Ann Surg. 2016; 263: 664-672
        • Halm E.A.
        • Lee C.
        • Chassin M.R.
        Is volume related to outcome in health care? A systematic review and methodologic critique of the literature.
        Annals of internal medicine. 2002; 137: 511-520
        • Chowdhury M.M.
        • Dagash H.
        • Pierro A.
        A systematic review of the impact of volume of surgery and specialization on patient outcome.
        BJS (British Journal of Surgery). 2007; 94: 145-161
        • Tjarda Van Heek N.
        • Kuhlmann K.F.D.
        • Scholten R.J.
        • De Castro S.M.M.
        • Busch O.R.C.
        • Van Gulik T.M.
        • et al.
        Hospital volume and mortality after pancreatic resection: A systematic review and an evaluation of intervention in The Netherlands.
        Annals of Surgery. 2005; 242: 781-790
      1. The Leapfrog Group. Factsheet: Adult and pediatric complex surgery 2022 [Available from: https://ratings.leapfroggroup.org/measure/hospital/complex-adult-and-pediatric-surgery.

        • Vonlanthen R.
        • Lodge P.
        • Barkun J.S.
        • Farges O.
        • Rogiers X.
        • Soreide K.
        • et al.
        Toward a Consensus on Centralization in Surgery.
        Annals of Surgery. 2018; 268: 712-724
        • Bauer H.
        • Honselmann K.C.
        Minimum Volume Standards in Surgery - Are We There Yet?.
        Visc Med. 2017; 33: 106-116
        • Moher D.
        • Liberati A.
        • Tetzlaff J.
        • Altman D.G.
        • Group P.
        Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement.
        PLoS medicine. 2009; 6e1000097
        • Page M.J.
        • Moher D.
        • Bossuyt P.M.
        • Boutron I.
        • Hoffmann T.C.
        • Mulrow C.D.
        • et al.
        PRISMA 2020 explanation and elaboration: updated guidance and exemplars for reporting systematic reviews.
        bmj. 2021; : 372
      2. Wells GA, Shea B, O’Connell D, Peterson J, Welch V, Losos M, et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in meta-analyses. Oxford; 2000.

        • Zhang Y.
        • Huang L.
        • Wang D.
        • Ren P.
        • Hong Q.
        • Kang D.
        The ROBINS‐I and the NOS had similar reliability but differed in applicability: A random sampling observational studies of systematic reviews/meta‐analysis.
        Journal of Evidence‐Based Medicine. 2021; 14: 112-122
        • Sterne J.A.
        • Hernán M.A.
        • Reeves B.C.
        • Savović J.
        • Berkman N.D.
        • Viswanathan M.
        • et al.
        ROBINS-I: a tool for assessing risk of bias in non-randomised studies of interventions.
        bmj. 2016; 355
        • Melsen W.G.
        • Bootsma M.C.J.
        • Rovers M.M.
        • Bonten M.J.M.
        The effects of clinical and statistical heterogeneity on the predictive values of results from meta-analyses.
        Clinical Microbiology and Infection. 2014; 20: 123-129
        • Rao G.
        • Lopez-Jimenez F.
        • Boyd J.
        • D’Amico F.
        • Durant N.H.
        • Hlatky M.A.
        • et al.
        Methodological standards for meta-analyses and qualitative systematic reviews of cardiac prevention and treatment studies: a scientific statement from the American Heart Association.
        Circulation. 2017; 136: e172-e194
        • Allareddy V.
        • Ward M.M.
        • Allareddy V.
        • Konety B.R.
        Effect of meeting Leapfrog volume thresholds on complication rates following complex surgical procedures.
        Annals of surgery. 2010; 251: 377-383
        • Amini N.
        • Spolverato G.
        • Kim Y.
        • Pawlik T.M.
        Trends in hospital volume and failure to rescue for pancreatic surgery.
        Journal of Gastrointestinal Surgery. 2015; 19: 1581-1592
        • Antila A.
        • Ahola R.
        • Sand J.
        • Laukkarinen J.
        Management of postoperative complications may favor the centralization of also distal pancreatectomies.
        Pancreas. 2018; 47: 1371-1372
        • Balzano G.
        • Zerbi A.
        • Capretti G.
        • Rocchetti S.
        • Capitanio V.
        • Di Carlo V.
        Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy.
        Br J Surg. 2008; 95: 357-362
        • Boudourakis L.D.
        • Wang T.S.
        • Roman S.A.
        • Desai R.
        • Sosa J.A.
        Evolution of the surgeon-volume, patient-outcome relationship.
        Annals of surgery. 2009; 250: 159-165
        • Colavita P.D.
        • Tsirline V.B.
        • Belyansky I.
        • Swan R.Z.
        • Walters A.L.
        • Lincourt A.E.
        • et al.
        Regionalization and Outcomes of Hepato-pancreato-biliary Cancer Surgery in USA.
        Journal of Gastrointestinal Surgery. 2014; 18: 532-541
      3. Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality.
        Journal of British Surgery. 2012; 99: 404-410
        • El Amrani M.
        • Clement G.
        • Lenne X.
        • Farges O.
        • Delpero J.R.
        • Theis D.
        • et al.
        Failure-to-rescue in Patients Undergoing Pancreatectomy: Is Hospital Volume a Standard for Quality Improvement Programs? Nationwide Analysis of 12,333 Patients.
        Ann Surg. 2018; 268: 799-807
        • Eppsteiner R.W.
        • Csikesz N.G.
        • McPhee J.T.
        • Tseng J.F.
        • Shah S.A.
        Surgeon volume impacts hospital mortality for pancreatic resection.
        Annals of surgery. 2009; 249: 635-640
        • Gasper W.J.
        • Glidden D.V.
        • Jin C.
        • Way L.W.
        • Patti M.G.
        Has recognition of the relationship between mortality rates and hospital volume for major cancer surgery in California made a difference?: A follow-up analysis of another decade.
        Annals of surgery. 2009; 250: 472-483
        • Ghaferi A.A.
        • Birkmeyer J.D.
        • Dimick J.B.
        Hospital volume and failure to rescue with high-risk surgery.
        Medical Care. 2011; 49: 1076-1081
        • Gooiker G.A.
        • Lemmens V.E.P.P.
        • Besselink M.G.
        • Busch O.R.
        • Bonsing B.A.
        • Molenaar I.Q.
        • et al.
        Impact of centralization of pancreatic cancer surgery on resection rates and survival.
        British Journal of Surgery. 2014; 101: 1000-1005
        • Guilbaud T.
        • Turrini O.
        • Lemoine C.
        • Le Treut Y.P.
        • Ouaissi M.
        • Moutardier V.
        • et al.
        Venous resection in pancreatic ductal adenocarcinoma: Impact of surgical experience on early postoperative courses.
        Anticancer Research. 2017; 37: 4205-4213
        • Güller U.
        • Warschkow R.
        • Ackermann C.J.
        • Schmied B.
        • Cerny T.
        • Ess S.
        Lower hospital volume is associated with higher mortality after oesophageal, gastric, pancreatic and rectal cancer resection.
        Swiss medical weekly. 2017; 147
        • Hayman A.V.
        • Fisher M.J.
        • Kluz T.
        • Merkow R.P.
        • Wang E.C.
        • Bentrem D.J.
        Is Illinois heeding the call to regionalize pancreatic surgery?.
        Journal of Surgical Oncology. 2013; 107: 685-691
        • Hill J.S.
        • McPhee J.T.
        • Whalen G.F.
        • Sullivan M.E.
        • Warshaw A.L.
        • Tseng J.F.
        In-hospital mortality after pancreatic resection for chronic pancreatitis: population-based estimates from the nationwide inpatient sample.
        Journal of the American College of Surgeons. 2009; 209: 468-476
        • Hyder O.
        • Dodson R.M.
        • Nathan H.
        • Schneider E.B.
        • Weiss M.J.
        • Cameron J.L.
        • et al.
        Influence of patient, physician, and hospital factors on 30-day readmission following pancreatoduodenectomy in the United States.
        JAMA surgery. 2013; 148: 1095-1102
        • Kagedan D.J.
        • Goyert N.
        • Li Q.
        • Paszat L.
        • Kiss A.
        • Earle C.C.
        • et al.
        The Impact of Increasing Hospital Volume on 90-Day Postoperative Outcomes Following Pancreaticoduodenectomy.
        Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract. 2017; 21: 506-515
        • Kim C.G.
        • Jo S.
        • Kim J.S.
        Impact of surgical volume on nationwide hospital mortality after pancreaticoduodenectomy.
        World Journal of Gastroenterology. 2012; 18: 4175-4181
        • Krautz C.
        • Nimptsch U.
        • Weber G.F.
        • Mansky T.
        • Grützmann R.
        Effect of hospital volume on in-hospital morbidity and mortality following pancreatic surgery in Germany.
        Annals of Surgery. 2018; 267: 411-417
        • Kutlu O.C.
        • Lee J.E.
        • Katz M.H.
        • Tzeng C.-W.D.
        • Wolff R.A.
        • Varadhachary G.R.
        • et al.
        Open pancreaticoduodenectomy case volume predicts outcome of laparoscopic approach: a population-based analysis.
        Annals of surgery. 2018; 267: 552-560
        • Lin H.-C.
        • Xirasagar S.
        • Lee H.-C.
        • Chai C.-Y.
        Hospital volume and inpatient mortality after cancer-related gastrointestinal resections: the experience of an Asian country.
        Annals of surgical oncology. 2006; 13: 1182-1188
        • Liu Z.
        • Peneva I.
        • Evison F.
        • Sahdra S.
        • Mirza D.
        • Charnley R.
        • et al.
        Ninety day mortality following pancreatoduodenectomy in England: has the optimum centre volume been identified?.
        Hpb. 2018; 20: 1012-1020
        • Murphy M.M.
        • Knaus I.W.J.
        • Ng S.C.
        • Hill J.S.
        • McPhee J.T.
        • Shah S.A.
        • et al.
        Total pancreatectomy: A national study.
        HPB. 2009; 11: 476-482
        • Nathan H.
        • Cameron J.L.
        • Choti M.A.
        • Schulick R.D.
        • Pawlik T.M.
        The volume-outcomes effect in hepato-pancreato-biliary surgery: hospital versus surgeon contributions and specificity of the relationship.
        J Am Coll Surg. 2009; 208: 528-538
        • Schneider E.B.
        • Hyder O.
        • Wolfgang C.L.
        • Dodson R.M.
        • Haider A.H.
        • Herman J.M.
        • et al.
        Provider versus patient factors impacting hospital length of stay after pancreaticoduodenectomy.
        Surgery. 2013; 154: 152-161
        • Sharpe S.M.
        • Talamonti M.S.
        • Wang C.E.
        • Prinz R.A.
        • Roggin K.K.
        • Bentrem D.J.
        • et al.
        Early national experience with laparoscopic pancreaticoduodenectomy for ductal adenocarcinoma: a comparison of laparoscopic pancreaticoduodenectomy and open pancreaticoduodenectomy from the National Cancer Data Base.
        Journal of the American College of Surgeons. 2015; 221: 175-184
        • Swanson R.S.
        • Pezzi C.M.
        • Mallin K.
        • Loomis A.M.
        • Winchester D.P.
        The 90-Day Mortality After Pancreatectomy for Cancer Is Double the 30-Day Mortality: More than 20,000 Resections From the National Cancer Data Base.
        Annals of Surgical Oncology. 2014; 21: 4059-4067
        • van der Geest L.G.M.
        • van Rijssen L.B.
        • Molenaar I.Q.
        • de Hingh I.H.
        • Groot Koerkamp B.
        • Busch O.R.C.
        • et al.
        Volume–outcome relationships in pancreatoduodenectomy for cancer.
        HPB. 2016; 18: 317-324
        • Yoshioka R.
        • Yasunaga H.
        • Hasegawa K.
        • Horiguchi H.
        • Fushimi K.
        • Aoki T.
        • et al.
        Impact of hospital volume on hospital mortality, length of stay and total costs after pancreaticoduodenectomy.
        Journal of British Surgery. 2014; 101: 523-529
        • Teh S.H.
        • Diggs B.S.
        • Deveney C.W.
        • Sheppard B.C.
        Patient and hospital characteristics on the variance of perioperative outcomes for pancreatic resection in the United States: A plea for outcome-based and not volume-based referral guidelines.
        Archives of Surgery. 2009; 144: 713-721
        • Mise Y.
        • Katz M.H.
        • Day R.W.
        • Brudvik K.W.
        • Schwarz L.
        • Conrad C.
        • et al.
        To capture complication-related readmission after pancreatectomy “90-days from surgery” is superior to “30-days from discharge”.
        Gastroenterology. 2015; 148: S1106-S1107
        • Allareddy V.
        • Allareddy V.
        • Konety B.R.
        Specificity of procedure volume and in-hospital mortality association.
        Ann Surg. 2007; 246: 135-139
        • Anema H.A.
        • van der Veer S.N.
        • Kievit J.
        • Krol-Warmerdam E.
        • Fischer C.
        • Steyerberg E.
        • et al.
        Influences of definition ambiguity on hospital performance indicator scores: examples from The Netherlands.
        The European Journal of Public Health. 2014; 24: 73-78
        • Verweij L.
        • Tra J.
        • Engel J.
        • Verheij R.
        • de Bruijne M.
        • Wagner C.
        Data quality issues impede comparability of hospital treatment delay performance indicators.
        Netherlands Heart Journal. 2015; 23: 420-427
        • Anema H.A.
        • Kievit J.
        • Fischer C.
        • Steyerberg E.W.
        • Klazinga N.S.
        Influences of hospital information systems, indicator data collection and computation on reported Dutch hospital performance indicator scores.
        BMC health services research. 2013; 13: 1-10
        • Wang C.-Y.
        • Brown J.
        Readmissions after pancreatic surgery in patients with pancreatic cancer: does hospital variation exist for quality measurement?.
        Visceral Medicine. 2020; 36: 304-311
        • Kontopantelis E.
        • Springate D.A.
        • Reeves D.
        A re-analysis of the Cochrane Library data: the dangers of unobserved heterogeneity in meta-analyses.
        PloS one. 2013; 8e69930
        • Talsma A.K.
        • Lingsma H.F.
        • Steyerberg E.W.
        • Wijnhoven B.P.
        • Van Lanschot JJB
        The 30-day versus in-hospital and 90-day mortality after esophagectomy as indicators for quality of care.
        Annals of surgery. 2014; 260: 267-273
        • Romano P.S.
        • Roos L.L.
        • Luft H.S.
        • Jollis J.G.
        • Doliszny K.
        • Team I.H.D.P.O.R.
        A comparison of administrative versus clinical data: coronary artery bypass surgery as an example.
        Journal of clinical epidemiology. 1994; 47: 249-260
        • Davenport D.L.
        • Holsapple C.W.
        • Conigliaro J.
        Assessing surgical quality using administrative and clinical data sets: a direct comparison of the University HealthSystem Consortium Clinical Database and the National Surgical Quality Improvement Program data set.
        American Journal of Medical Quality. 2009; 24: 395-402
        • Tang P.C.
        • Ralston M.
        • Arrigotti M.F.
        • Qureshi L.
        • Graham J.
        Comparison of methodologies for calculating quality measures based on administrative data versus clinical data from an electronic health record system: implications for performance measures.
        Journal of the American Medical Informatics Association. 2007; 14: 10-15