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| |  Surgical Experience Counts In Pancreatic Cancer Surgery BALTIMORE, MD -- December 19, 1997 -- A Johns Hopkins study of Maryland patients seeking surgery for pancreatic cancer found fewer in-patient deaths and shorter lengths of stay without increased costs at hospitals that perform the greatest number of procedures for pancreatic cancer. According to the study, presented at the October meeting of the American College of Surgeons, short-term clinical and economic outcomes from procedures designed to cure or relieve pancreatic cancer symptoms are significantly better when performed by the most experienced medical teams. The researchers examined the outcomes of 1,236 patients in Maryland who underwent various medical procedures for pancreatic cancer: 496 had a curative operation (Whipple procedure or a total pancreatectomy); 542 had a palliative bypass (for symptom relief); and 198 had a biliary stent placed. Forty-three percent of the procedures were performed at just one hospital (the high-volume provider); 22% were performed at the seven medium-volume centers and 35% were done at 40 low-volume hospitals. In-hospital mortality rates for patients undergoing curative operations were 0.9% at the high-volume hospital; 6.9% at the medium-volume providers; and 18.8% at the low-volume providers. For patients undergoing bypass procedures, the in-hospital mortality rates were 4.2%, 10.5% and 15.3%, respectively. For patients who received stents, the rates were 1.6%, 10.9% and 9.8%, respectively. Even when the researchers took into account differences in patient characteristics, large differences in mortality remained. For example, the relative risk of dying while hospitalized after a curative operation in a low- or medium-volume hospital was eight times that of the high-volume hospital. How long patients remained in bed after their surgery also was associated with hospital volume for all the pancreatic cancer procedures. Length-of-stay at the high-volume hospital was significantly lower than at the medium-volume (16.3 versus 18.8 days) and low-volume hospitals (19.4 days) for curative operations, and lower than at the low-volume hospitals for bypasses (14.3 versus 16.3 days) and stent procedures (4.6 versus 6.7 days). What's more, curative operations performed at the high-volume hospital cost significantly less; $20,186, compared to $26,455 at the low-volume providers.
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