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Invited Critique
August 14, 2009

Patient and Hospital Characteristics on the Variance of Perioperative Outcomes for Pancreatic Resection in the United States—Invited Critique

Arch Surg. 2009;144(8):721. doi:10.1001/archsurg.2009.21

Teh and colleagues' well-written retrospective cohort study used the Nationwide Inpatient Sample to determine perioperative outcomes for major pancreatic resections across surgical centers in the United States. Some 103 222 cases were reviewed during a 16-year period from 1988 to 2003. Using a multivariate model, they determined that age, male sex, medical comorbidity, and hospital volume for each of 3 types of pancreatic resection (pancreatoduodenectomy, distal pancreatectomy, and total pancreatectomy) were independent predictors of operative mortality and postoperative complications. They opine that volume-based referrals undermine local expertise and may leave patients far from supportive social networks. As an alternative, they recommend the establishment of risk-adjusted outcome-based (rather than volume-based) guidelines to improve quality of care, optimize resource utilization, and support local community care delivery.