HPB : the official journal of the International Hepato Pancreato Biliary Association
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The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) was started in 2004. Presently, 58% of the 198 hospitals participating in ACS-NSQIP are academic or teaching hospitals. In 2008, ACS-NSQIP initiated a number of changes and made risk-adjusted data available for use by participating hospitals. This analysis explores the ACS-NSQIP database for utility in developing hepato-pancreato-biliary (HPB) surgery-specific outcomes (HPB-NSQIP). ⋯ These data suggest that HPB operations performed at ACS-NSQIP hospitals have acceptable outcomes. However, the creation of an HPB-NSQIP has the potential to improve quality, provide risk-adjusted registries with HPB-specific data and facilitate multi-institutional clinical trials.
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The optimal management of acute pancreatitis remains controversial and current treatment protocols vary in degrees of medical and surgical management. Our group has previously shown in population-based studies that high-volume (HV) hospitals have lower rates of in-hospital mortality after pancreatectomy. We sought to examine if a similar mortality benefit exists for patients admitted with acute pancreatitis. ⋯ Rates of admissions for acute pancreatitis in the USA are increasing. High annual hospital volume of acute pancreatitis cases confers a shorter LOS, lower adjusted mortality and a lower likelihood of pancreatic procedure for patients admitted with acute pancreatitis. Although HV hospitals were less likely than MV or LV centres to perform pancreatic procedures, the role of surgery remains unclear. Further studies should examine other possible reasons for this mortality benefit, such as the availability of specialists, the quality of critical care facilities and the timing of operative intervention.
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In patients with hilar cholangiocarcinoma, ipsilateral en bloc hepatic resection improves survival but is associated with increased morbidity. Preoperative biliary drainage of the future liver remnant (FLR) and contralateral portal vein embolization (PVE) may improve perioperative outcome, but their routine use is controversial. This study analyses the impact of FLR volume and preoperative biliary drainage on postoperative hepatic insufficiency and mortality rates. ⋯ In patients undergoing liver resection for hilar cholangiocarcinoma, FLR volume of < 30% of total liver volume is associated with increased risk for hepatic insufficiency and death. Preoperative biliary drainage of the FLR appears to improve outcome if the predicted volume is < 30%. However, in patients with FLR > or = 30%, preoperative biliary drainage does not appear to improve perioperative outcome and, as many of these patients have hypertrophy of the FLR, PVE is likely to offer little benefit.