Impact of hospital volume on mortality, morbidity and quantity of dissected lymph nodule for pancreaduodenectomy operation done for periampullary tumors


Thesis Type: Expertise In Medicine

Institution Of The Thesis: Gazi Üniversitesi, Tıp Fakültesi, Turkey

Approval Date: 2016

Student: VEYSEL BARIŞ TURHAN

Supervisor: MUSTAFA KEREM

Abstract:

Purpose: It is well known that since the very first pancreaduodenectomy (PD) operations, amount of uncomplicated cases as well as mortality, morbidity, quantity of dissected lymph nodules and duration of stay in hospital improves as years pass. For a complex surgery like PD, It can easily be assumed that there is a correlation between hospital volume and recovery of the patient. Method: 213 patients who had been diagnosed with periampullary tumor and operated between the dates of January 2008 and January 2016 by 3 surgeons of Gazi University General Surgery Department are included into the study. Patients are divided into four groups according to the years they had been operated in, the said groups being Group A (2008-2009), Group B (2010-2011), Group C ( 2012-2013) Group D ( 2014-2016). Groups are compared with one another regarding the following factors: Pancreatic fistül rates, postoperation hospital stay duration, mortality rates, morbidity rates, quantity of dissected lymph nodules. Results: It has been observed that there is a relation between pancreatic tissue quality and duct size with fistules. In cases which metastasis are present in dissected lymph nodules, 1 and 3 years survival rates were found to be lower compared to those without such metastasis and the cut-off value for the amount of dissected lymph nodules can be safely assumed as 13. It is seen that as the amount of dissected lymph nodules increases, the quality of staging also improves. For mortality and morbidity rates, as hospital volume increases, they are reduced. The same effect of hospital volume is also observed on hospital stay duration and fistule rates, improving them both. Conclusion: The relation between hospital volume and patient outcome, It is easy to state that as hospital volume increases, so does the general experience of the surgeon. As the understanding of anatomy increases, quality of the operation can be assumed to increase as well with the end result being a general reduction of mortality and morbidity rates, increased quantity of dissected lymph nodules and shorter hospital stay.