Trends and disparities in regionalization of pancreatic resection

Background The current recommendation is that pancreatic resections be performed at hospitals doing > 10 pancreatic resections annually. Objective To evaluate the extent of regionalization of pancreatic resection and the factors predicting resection at high-volume centers (> 10 cases/ year) in Texas. Methods Using the Texas Hospital Inpatient Discharge Public Use Data File, we evaluated trends in the percentage of patients undergoing pancreatic resection at high- volume centers (> 10 cases/ year) from 1999 to 2004 and determined the factors that independently predicted resection at high- volume centers. Results A total of 3,189 pancreatic resections were performed in the state of Texas. The unadjusted in- hospital mortality was higher at low- volume centers ( 7.4%) compared to high- volume centers ( 3.0%). Patients resected at high- volume centers increased from 54.5% in 1999 to 63.3% in 2004 ( P= 0.0004). This was the result of a decrease in resections performed at centers doing less than five resections/ year ( 35.5% to 26.0%). In a multivariate analysis, patients who were > 75 ( OR= 0.51), female ( OR= 0.86), Hispanic ( OR= 0.58), having emergent surgery ( OR= 0.39), diagnosed with periampullary cancer ( OR= 0.68), and living > 75 mi from a high- volume center ( OR= 0.93 per 10- mi increase in distance, P< 0.05 for all OR) were less likely to be resected at high- volume centers. The odds of being resected at a high- volume center increased 6% per year. Conclusions Whereas regionalization of pancreatic resection at high- volume centers in the state of Texas has improved slightly over time, 37% of patients continue to undergo pancreatic resection at low- volume centers, with more than 25% occurring at centers doing less than five per year. There are obvious demographic disparities in the regionalization of care, but additional unmeasured barriers need to be identified.