Centralization of pancreatoduodenectomy a decade later: Impact of the volume–outcome relationship

Background The hospital volume–outcome relationship for complex procedures has led to the suggestion that care should be centralized. This study was performed to investigate whether centralization is occurring for pancreatoduodenectomy (PD) and to examine its effect on short-term postoperative outcomes. Methods We queried the New York State Statewide Planning and Research Cooperative System database ( n = 6,185, 2002–2011) and the California and Florida State Inpatient Databases ( n = 6,766 and 4,810, respectively, 2002–2011) for PD. Hospitals were divided into low (≤10), medium (11–25), high (25–60), and very high (≥61) groups depending on annual volume. Hierarchical logistic modeling accounted for patient clustering within hospitals. Results A migration of cases from low-volume to medium, high, and very high-volume (MHVH) hospitals occurred in these 3 states ( P