Background

An association between higher hospital-volume and better “quality of surgery” and long-term survival has not been reported following pancreatic cancer surgery in low resection-volume regions such as in Australia. Using a population-level study, we compare “quality of surgery” and two-year survival following pancreaticoduodenectomy between Australian hospitals grouped by resection-volume.

Methods

Data on all patients undergoing pancreaticoduodenectomy for adenocarcinoma in the Australian state of Queensland, between 2001 and 2015, were obtained from the Queensland Oncology Repository. Hospitals were grouped into high (≥6 resections annually) and low (<6) volume centres. Following adjustment for case-mix, “quality-of-treatment” indicators were compared between hospital groups using multivariate logistic regression and Poisson regression analysis; and two-year cancer-specific and overall survival were compared using multivariate Cox proportional hazard models.

Results

Compared with high-volume centres, low-volume centres had worse two-year cancer-specific survival (Adjusted HR = 1.31; 95% CI:1.03–1.68), higher 30-day mortality (Adjusted IRR = 3.81; 95% CI: 1.36–10.62) and fewer patients received “high-quality surgery” (Adjusted OR = 0.55; 95% CI: 0.33–0.90). Differences in 30-day mortality, or “quality-of-treatment” indicators did not entirely explain the observed survival difference between hospital-volume groups.

Conclusion

In an Australian environment, a “high” hospital-volume was significantly associated with better quality surgery and two-year survival following pancreaticoduodenectomy.

中文翻译：

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低切除量区域的胰十二指肠切除术：一项人口水平的研究，检查医院量对手术质量和长期生存的影响。

背景

在澳大利亚等低切除量地区，胰腺癌手术后更高的医院容量和更好的“手术质量”与长期生存之间的关联尚未见报道。使用一项人群水平的研究，我们比较了按切除量分组的澳大利亚医院胰十二指肠切除术后的“手术质量”和两年生存率。

方法

2001 年至 2015 年期间，澳大利亚昆士兰州因腺癌接受胰十二指肠切除术的所有患者的数据均来自昆士兰肿瘤学资料库。医院被分为高（每年≥6 次切除）和低（<6）容量中心。在调整病例组合后，使用多元逻辑回归和泊松回归分析比较医院组之间的“治疗质量”指标；使用多变量 Cox 比例风险模型比较了两年癌症特异性生存率和总生存率。

结果

与高容量中心相比，低容量中心的两年癌症特异性生存率更差（调整后的 HR = 1.31；95% CI：1.03–1.68）、更高的 30 天死亡率（调整后的 IRR = 3.81；95% CI： 1.36–10.62），接受“高质量手术”的患者更少（调整后的 OR = 0.55；95% CI：0.33–0.90）。30 天死亡率或“治疗质量”指标的差异并不能完全解释所观察到的医院数量组之间的生存差异。

结论

在澳大利亚环境中，“高”医院容量与胰十二指肠切除术后更好的手术质量和两年生存率显着相关。