dc.contributor.author | Nymo, Linn Såve | |
dc.contributor.author | Kleive, Dyre | |
dc.contributor.author | Waardal, Kim | |
dc.contributor.author | Bringeland, Erling Audun | |
dc.contributor.author | Søreide, Jon Arne | |
dc.contributor.author | Labori, Knut Jørgen | |
dc.contributor.author | Mortensen, Kim Erlend | |
dc.contributor.author | Søreide, Kjetil | |
dc.contributor.author | Lassen, Kristoffer | |
dc.date.accessioned | 2021-05-03T13:43:34Z | |
dc.date.available | 2021-05-03T13:43:34Z | |
dc.date.created | 2020-11-29T13:53:38Z | |
dc.date.issued | 2020 | |
dc.Published | BJS Open. 2020, 4 (5), 904-913. | |
dc.identifier.issn | 2474-9842 | |
dc.identifier.uri | https://hdl.handle.net/11250/2753329 | |
dc.description.abstract | Background
Centralization of pancreatic surgery is currently called for owing to superior outcomes in higher-volume centres. Conversely, organizational and patient concerns speak for a moderation in centralization. Consensus on the optimal balance has not yet been reached. This observational study presents a volume–outcome analysis of a complete national cohort in a health system with long-standing centralization.
Methods
Data for all pancreatoduodenectomies in Norway in 2015 and 2016 were identified through a national quality registry and completed through electronic patient journals. Hospitals were dichotomized (high-volume (40 or more procedures/year) or medium–low-volume).
Results
Some 394 procedures were performed (201 in high-volume and 193 in medium–low-volume units). Major postoperative complications occurred in 125 patients (31·7 per cent). A clinically relevant postoperative pancreatic fistula occurred in 66 patients (16·8 per cent). Some 17 patients (4·3 per cent) died within 90 days, and the failure-to-rescue rate was 13·6 per cent (17 of 125 patients). In multivariable comparison with the high-volume centre, medium–low-volume units had similar overall complication rates, lower 90-day mortality (odds ratio 0·24, 95 per cent c.i. 0·07 to 0·82) and no tendency for a higher failure-to-rescue rate.
Conclusion
Centralization beyond medium volume will probably not improve on 90-day mortality or failure-to-rescue rates after pancreatoduodenectomy. | en_US |
dc.language.iso | eng | en_US |
dc.publisher | Oxford University Press | en_US |
dc.rights | Navngivelse-Ikkekommersiell 4.0 Internasjonal | * |
dc.rights.uri | http://creativecommons.org/licenses/by-nc/4.0/deed.no | * |
dc.title | Centralizing a national pancreatoduodenectomy service: striking the right balance | en_US |
dc.type | Journal article | en_US |
dc.type | Peer reviewed | en_US |
dc.description.version | publishedVersion | en_US |
dc.rights.holder | Copyright 2020 The Authors | en_US |
cristin.ispublished | true | |
cristin.fulltext | original | |
cristin.qualitycode | 1 | |
dc.identifier.doi | 10.1002/bjs5.50342 | |
dc.identifier.cristin | 1853762 | |
dc.source.journal | BJS Open | en_US |
dc.source.40 | 4 | |
dc.source.14 | 5 | |
dc.source.pagenumber | 904-913 | en_US |
dc.identifier.citation | BJS Open. 2020, 4(5), 904–913 | en_US |
dc.source.volume | 4 | en_US |
dc.source.issue | 5 | en_US |