Centralisatie pancreaschirurgie reduceert postoperatieve sterfte in Nederland*

R.F. de Wilde, M.G. Besselink, I.H. Rinkes, I.H. de Hingh, C.H. van Eijck, C.H.C. Dejong, R.J. Porte, D.J. Gouma, O.R. Busch, I.Q. Molenaar

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Abstract

OBJECTIVE: To analyse the extent of centralisation of pancreaticoduodenectomy (Whipple procedure) and changes in in-hospital mortality rates in the Netherlands. DESIGN: Retrospective analysis. METHODS: Data on patients who had undergone pancreaticoduodenectomy (PD) during the 2004-2009 period was acquired from the Kiwa Prismant registry. Based on the number of procedures performed annually, hospitals were divided into 4 volume-categories: very-low (<5), low (5-10), medium (11-19) and high (>/=20). Changes in volume and in-hospital mortality were analysed per volume category. A subgroup analysis based on age was also performed. RESULTS: 2155 patients who had undergone PD were included. The number of hospitals performing PD decreased from 48 in 2004 to 30 in 2009 (p = 0.01). The proportion of patients who had undergone PD in a medium- or high-volume hospital increased from 52.9% to 91.2% (p < 0.001). Post-operative mortality rates decreased from 9.8% to 5.1% (p = 0.04). Average mortality was 14.7%, 9.8%, 6.3% and 3.3% in very low-, low-, medium-, and high-volume hospitals, respectively (p < 0.001). The difference in mortality between medium- and high-volume hospitals was statistically significant (p = 0.004). The mortality rate in patients >/= 70 years was 10.4% compared with 4.4% in younger patients (p < 0.001). CONCLUSION : Nationwide centralisation of PD is occurring in Netherlands, and this is associated with a decrease in in-hospital mortality. Further centralisation is likely to further decrease in-hospital mortality, especially in the elderly.
Original languageEnglish
Pages (from-to)A4791
JournalNederlands Tijdschrift voor Geneeskunde
Volume156
Issue number32
Publication statusPublished - 1 Jan 2012

Cite this

de Wilde, R. F., Besselink, M. G., Rinkes, I. H., de Hingh, I. H., van Eijck, C. H., Dejong, C. H. C., Porte, R. J., Gouma, D. J., Busch, O. R., & Molenaar, I. Q. (2012). Centralisatie pancreaschirurgie reduceert postoperatieve sterfte in Nederland*. Nederlands Tijdschrift voor Geneeskunde, 156(32), A4791. http://www.ncbi.nlm.nih.gov/pubmed/http://www.ncbi.nlm.nih.gov/pubmed/22871250