Is Centralization Needed for Patients ...
Document type :
Article dans une revue scientifique: Article original
Title :
Is Centralization Needed for Patients Undergoing Distal Pancreatectomy?
Author(s) :
Roussel, Edouard [Auteur]
Hôpital Charles Nicolle [Rouen]
Clément, Guillaume [Auteur]
Centre de recherche sur les Ions, les MAtériaux et la Photonique [CIMAP - UMR 6252]
Lenne, Xavier [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Pruvot, François-René [Auteur]
Hôpital Claude Huriez [Lille]
Schwarz, Lilian [Auteur]
Génomique et Médecine Personnalisée du Cancer et des Maladies Neuropsychiatriques [GPMCND]
Service de Chirurgie Digestive [CHU Rouen]
Theis, Didier [Auteur]
Université Lille Nord (France)
Truant, Stéphanie [Auteur]
Hétérogénéité, Plasticité et Résistance aux Thérapies des Cancers = Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277 [CANTHER]
El Amrani, Mehdi [Auteur]
Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 [JPArc]
Hôpital Charles Nicolle [Rouen]
Clément, Guillaume [Auteur]
Centre de recherche sur les Ions, les MAtériaux et la Photonique [CIMAP - UMR 6252]
Lenne, Xavier [Auteur]
Centre Hospitalier Régional Universitaire [CHU Lille] [CHRU Lille]
Pruvot, François-René [Auteur]
Hôpital Claude Huriez [Lille]
Schwarz, Lilian [Auteur]
Génomique et Médecine Personnalisée du Cancer et des Maladies Neuropsychiatriques [GPMCND]
Service de Chirurgie Digestive [CHU Rouen]
Theis, Didier [Auteur]
Université Lille Nord (France)
Truant, Stéphanie [Auteur]
Hétérogénéité, Plasticité et Résistance aux Thérapies des Cancers = Cancer Heterogeneity, Plasticity and Resistance to Therapies - UMR 9020 - U 1277 [CANTHER]
El Amrani, Mehdi [Auteur]
Centre de Recherche Jean-Pierre AUBERT Neurosciences et Cancer - U837 [JPArc]
Journal title :
Pancreas
Pages :
1188-1194
Publication date :
2019-10-08
ISSN :
0885-3177
HAL domain(s) :
Sciences du Vivant [q-bio]
English abstract : [en]
Objective The centralization of complex surgical procedures is associated with better postoperative outcomes. However, little is known about the impact of hospital volume on the outcome after distal pancreatectomy. Methods ...
Show more >Objective The centralization of complex surgical procedures is associated with better postoperative outcomes. However, little is known about the impact of hospital volume on the outcome after distal pancreatectomy. Methods Using the French national hospital discharge database, we identified all patients having undergone distal pancreatectomy in France between 2012 and 2015. A spline model was applied to determine the caseload cut-off in annual distal pancreatectomy that influenced 90-day postoperative mortality. Results A total of 3314 patients were identified. Use of a spline model did not reveal a cut-off in the annual distal pancreatectomy caseload. By taking the median number of distal pancreatectomy (n = 5) and the third quartile (n = 15), we stratified centers into low, intermediate, and high hospital volume groups. The overall postoperative mortality rate was 3.0% and did not differ significantly between these groups. In a multivariable analysis, age, Charlson comorbidity score, septic complications, hemorrhage, shock, and reoperation were independently associated with a greater overall risk of death. However, hospital volume had no impact on mortality after distal pancreatectomy (odds ratio, 0.954; 95% confidence interval, 0.552–1.651, P = 0.867). Conclusions Hospital volume does not seem to influence mortality after distal pancreatectomy in France, and centralization may not necessarily improve outcomes.Show less >
Show more >Objective The centralization of complex surgical procedures is associated with better postoperative outcomes. However, little is known about the impact of hospital volume on the outcome after distal pancreatectomy. Methods Using the French national hospital discharge database, we identified all patients having undergone distal pancreatectomy in France between 2012 and 2015. A spline model was applied to determine the caseload cut-off in annual distal pancreatectomy that influenced 90-day postoperative mortality. Results A total of 3314 patients were identified. Use of a spline model did not reveal a cut-off in the annual distal pancreatectomy caseload. By taking the median number of distal pancreatectomy (n = 5) and the third quartile (n = 15), we stratified centers into low, intermediate, and high hospital volume groups. The overall postoperative mortality rate was 3.0% and did not differ significantly between these groups. In a multivariable analysis, age, Charlson comorbidity score, septic complications, hemorrhage, shock, and reoperation were independently associated with a greater overall risk of death. However, hospital volume had no impact on mortality after distal pancreatectomy (odds ratio, 0.954; 95% confidence interval, 0.552–1.651, P = 0.867). Conclusions Hospital volume does not seem to influence mortality after distal pancreatectomy in France, and centralization may not necessarily improve outcomes.Show less >
Language :
Anglais
Peer reviewed article :
Oui
Audience :
Internationale
Popular science :
Non
Collections :
Source :