Regionalization of pancreatic surgery in California: Benefits for preventing postoperative deaths and reducing healthcare costs
Introduction: Pancreatic cancer (PC) surgery has been associated with improved outcomes and value when performed at high-volume centers (HVC; ≥20 surgeries annually) compared to low-volume centers (LVC). Some have used these differences to suggest that regionalization of PC surgery would optimize pa...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-12-01
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| Series: | Surgery Open Science |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2589845023001021 |
| _version_ | 1797398568275804160 |
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| author | Lauren M. Perry, MD Robert J. Canter, MD Cameron E. Gaskill, MD, MPH Richard J. Bold, MD, MBA |
| author_facet | Lauren M. Perry, MD Robert J. Canter, MD Cameron E. Gaskill, MD, MPH Richard J. Bold, MD, MBA |
| author_sort | Lauren M. Perry, MD |
| collection | DOAJ |
| description | Introduction: Pancreatic cancer (PC) surgery has been associated with improved outcomes and value when performed at high-volume centers (HVC; ≥20 surgeries annually) compared to low-volume centers (LVC). Some have used these differences to suggest that regionalization of PC surgery would optimize patient outcomes and expenditures. Methods: A Markov model was created to evaluate 30-day mortality, 30-day complications, and 30-day costs. The differences in these outcome measures between the current and future states were measured to assess the population-level benefits of regionalization. A sensitivity analysis was performed to evaluate the impact of variations of input variables in the model. Results: Among 5958 new cases of pancreatic cancer in California in 2021, a total of 2443 cases (41 %) would be resectable; among patients with resectable PC, a total of 977 (40 %) patients would undergo surgery. In aggregate, HVC and LVC 30-day postoperative complications occurred in 364 patients, 30-day mortality in 35 patients, and healthcare costs expended managing complications were $6,120,660. In the predictive model of complete regionalization to only HVC in California, an estimated 29 fewer complications, 17 fewer deaths, and a cost savings of $487,635 per year would occur. Conclusions and relevance: Pancreatic cancer (PC) surgery has been associated with improved outcomes and value when performed at high-volume centers (HVC; ≥20 surgeries annually) compared to low-volume centers (LVC). Complete regionalization of pancreatic cancer surgery predicted benefits in mortality, complications and cost, though implementing this strategy at a population-level may require investment of resources and redesigning care delivery models. |
| first_indexed | 2024-03-09T01:27:22Z |
| format | Article |
| id | doaj.art-7758eb4898ba4962bcd03c8b5023d386 |
| institution | Directory Open Access Journal |
| issn | 2589-8450 |
| language | English |
| last_indexed | 2024-03-09T01:27:22Z |
| publishDate | 2023-12-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Surgery Open Science |
| spelling | doaj.art-7758eb4898ba4962bcd03c8b5023d3862023-12-10T06:17:09ZengElsevierSurgery Open Science2589-84502023-12-0116198204Regionalization of pancreatic surgery in California: Benefits for preventing postoperative deaths and reducing healthcare costsLauren M. Perry, MD0Robert J. Canter, MD1Cameron E. Gaskill, MD, MPH2Richard J. Bold, MD, MBA3Division of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Sacramento, United States of AmericaDivision of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Sacramento, United States of AmericaDivision of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Sacramento, United States of AmericaCorresponding author at: UC Davis Comprehensive Cancer Center, 4501 X Street, Suite 3010, Sacramento, CA 95817, United States of America.; Division of Surgical Oncology, Department of Surgery, University of California, Davis, Medical Center, Sacramento, United States of AmericaIntroduction: Pancreatic cancer (PC) surgery has been associated with improved outcomes and value when performed at high-volume centers (HVC; ≥20 surgeries annually) compared to low-volume centers (LVC). Some have used these differences to suggest that regionalization of PC surgery would optimize patient outcomes and expenditures. Methods: A Markov model was created to evaluate 30-day mortality, 30-day complications, and 30-day costs. The differences in these outcome measures between the current and future states were measured to assess the population-level benefits of regionalization. A sensitivity analysis was performed to evaluate the impact of variations of input variables in the model. Results: Among 5958 new cases of pancreatic cancer in California in 2021, a total of 2443 cases (41 %) would be resectable; among patients with resectable PC, a total of 977 (40 %) patients would undergo surgery. In aggregate, HVC and LVC 30-day postoperative complications occurred in 364 patients, 30-day mortality in 35 patients, and healthcare costs expended managing complications were $6,120,660. In the predictive model of complete regionalization to only HVC in California, an estimated 29 fewer complications, 17 fewer deaths, and a cost savings of $487,635 per year would occur. Conclusions and relevance: Pancreatic cancer (PC) surgery has been associated with improved outcomes and value when performed at high-volume centers (HVC; ≥20 surgeries annually) compared to low-volume centers (LVC). Complete regionalization of pancreatic cancer surgery predicted benefits in mortality, complications and cost, though implementing this strategy at a population-level may require investment of resources and redesigning care delivery models.http://www.sciencedirect.com/science/article/pii/S2589845023001021Pancreatic surgeryVolume:outcome relationshipRegionalization |
| spellingShingle | Lauren M. Perry, MD Robert J. Canter, MD Cameron E. Gaskill, MD, MPH Richard J. Bold, MD, MBA Regionalization of pancreatic surgery in California: Benefits for preventing postoperative deaths and reducing healthcare costs Surgery Open Science Pancreatic surgery Volume:outcome relationship Regionalization |
| title | Regionalization of pancreatic surgery in California: Benefits for preventing postoperative deaths and reducing healthcare costs |
| title_full | Regionalization of pancreatic surgery in California: Benefits for preventing postoperative deaths and reducing healthcare costs |
| title_fullStr | Regionalization of pancreatic surgery in California: Benefits for preventing postoperative deaths and reducing healthcare costs |
| title_full_unstemmed | Regionalization of pancreatic surgery in California: Benefits for preventing postoperative deaths and reducing healthcare costs |
| title_short | Regionalization of pancreatic surgery in California: Benefits for preventing postoperative deaths and reducing healthcare costs |
| title_sort | regionalization of pancreatic surgery in california benefits for preventing postoperative deaths and reducing healthcare costs |
| topic | Pancreatic surgery Volume:outcome relationship Regionalization |
| url | http://www.sciencedirect.com/science/article/pii/S2589845023001021 |
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