Variation in Hospital Utilization of Minimally Invasive Distal Pancreatectomy for Localized Pancreatic Neoplasms
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ORIGINAL ARTICLE
Variation in Hospital Utilization of Minimally Invasive Distal Pancreatectomy for Localized Pancreatic Neoplasms Ryan J. Ellis 1,2,3 & Lindsey M. Zhang 1,2,4 & Clifford Y. Ko 1,5,6 & Mark E. Cohen 1 & David J. Bentrem 2,3 & Karl Y. Bilimoria 1,2,3 & Anthony D. Yang 2,3 & Mark S. Talamonti 7,8 & Ryan P. Merkow 1,2,3 Received: 28 July 2019 / Accepted: 12 September 2019 # 2019 The Society for Surgery of the Alimentary Tract
Abstract Background Minimally invasive distal pancreatectomy (MIDP) for localized neoplasms has been demonstrated to be feasible and safe. However, national adoption of the technique is poorly understood. Objectives of this study were to identify factors associated with use of minimally invasive distal pancreatectomy for localized neoplasms and assess hospital variation in MIDP utilization. Methods Retrospective cohort study of patients with pancreatic cysts, stage I pancreatic ductal adenocarcinoma, and stage I pancreatic neuroendocrine tumors undergoing distal pancreatectomy from the ACS NSQIP Pancreas Targeted Dataset. Factors associated with use of MIDP were identified using multivariable logistic regression and hospital-level variation was assessed. Results Analysis included 3,059 patients at 139 hospitals. Overall, 64.5% of patients underwent minimally invasive distal pancreatectomy. Patients were more likely to undergo MIDP if they had lower ASA classification (P = 0.004) or BMI ≥ 30 (P < 0.001) and less likely if they had pancreatic adenocarcinoma (P < 0.001). There was notable hospital variability in utilization (range 0 to 100% of cases). Hospital-level utilization of minimally invasive distal pancreatectomy did not appear to be driven by patient selection, as hierarchical analysis demonstrated that only 1.8% of observed hospital variation was attributable to measured patient selection factors. Conclusion Utilization of MIDP for localized pancreatic neoplasms is highly variable. While some patient-level factors are associated with MIDP use, hospital adoption of MIDP appears to be the primary driver of utilization. Monitoring hospitallevel use of MIDP may be a useful quality measure to monitor uptake of emerging techniques in pancreatic surgery. Keywords Health services research . Surgical quality . Pancreatic surgery . Distal pancreatectomy
Meeting Presentation: This work was presented as a poster at the Americas Hepato-Pancreato-Biliary Association 2019 Annual Meeting in Miami, FL. * Ryan P. Merkow [email protected]
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Department of Surgery, University of Chicago Medicine, Chicago IL USA
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Division of Research and Optimal Patient Care, American College of Surgeons, Chicago IL USA
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Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles CA USA
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Department of Surgery, Surgical Outcomes and Quality Improvement Center (SOQIC), Feinberg School of Medicine, Northwestern University, 633 N St Clair St, 20th Floor Chicago IL 60611 USA
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VA Greater Los Angeles Healthcare System, Los Angeles CA USA
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Department of Sur
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