In‐hospital survival after pancreatoduodenectomy is greater in high‐volume hospitals versus lower‐volume hospitals: a meta‐analysis

作者：Joshua G. Kovoor, Ning Ma, David Tivey, Meegan Vandepeer, Jonathan Henry W. Jacobsen, Anje Scarfe, Thomas Vreugdenburg, Brandon Stretton, Suzanne Edwards, Wendy Babidge, Adrian Anthony, Robert T. A. Padbury, Guy J. Maddern · 发表于：ANZ Journal of Surgery · 年份：2021 · DOI：10.1111/ans.17293 · 被引用次数：16 · 研究领域：Pancreatic and Hepatic Oncology Research、Pancreatitis Pathology and Treatment、Gallbladder and Bile Duct Disorders

BACKGROUND: Variation in cut-off values for what is considered a high volume (HV) hospital has made assessments of volume-outcome relationships for pancreaticoduodenectomy (PD) challenging. Accordingly, we performed a systematic review and meta-analysis comparing in-hospital mortality after PD in hospitals above and below HV thresholds of various cut-off values. METHOD: PubMed/MEDLINE, Embase and Cochrane Library were searched to 4 January 2021 for studies comparing in-hospital mortality after PD in hospitals above and below defined HV thresholds. After data extraction, risk of bias was assessed using the Downs and Black checklist. A random-effects model was used for meta-analysis, including meta-regressions. Registration: PROSPERO, CRD42021224432. RESULTS: From 1855 records, 17 observational studies of moderate quality were included. Median HV cut-off was 25 PDs/year (IQR: 20-32). Overall relative risk of in-hospital mortality was 0.37 (95% CI: 0.30, 0.45), that is, 63% less in HV hospitals. All subgroup analyses found an in-hospital survival benefit in performing PDs at HV hospitals. Meta-regressions from included studies found no statistically significant associations between relative risk of in-hospital mortality and region (USA vs. non-USA; p = 0.396); or 25th percentile (p = 0.231), median (p = 0.822) or 75th percentile (p = 0.469) HV cut-off values. Significant inverse relationships were found between PD hospital volume and other outcomes. CONCLUSION: In-hospital survi...