TOPLINE:

A US analysis found that nearly one quarter of pancreatic cancer surgeries were done at low-volume centers, with double the mortality rates of high-volume centers. Black, Hispanic, and low-income patients disproportionately received care at low-volume hospitals.

METHODOLOGY:

• Pancreaticoduodenectomy and total pancreatectomy are complex, high-risk operations with better outcomes at high-volume centers. In this study, researchers quantified the number of procedures done at low-volume US centers and examined factors associated with receiving care there.
• Using data from the National Cancer Database, they analyzed 63,385 patients who underwent pancreaticoduodenectomy or total pancreatectomy at 881 facilities between 2011 and 2021, capturing more than 70% of newly diagnosed cancer cases annually. Facilities were classified as high volume when 10 or more procedures were performed in a year; volume status could vary by year.
• Outcomes included overall survival, surgical margins, hospital length of stay, 30- and 90-day mortality, and 30-day hospital readmission. Multivariable Cox regression was used to control for histology, stage, neoadjuvant treatment, and patients’ age, race, insurance status, and median neighborhood income.

TAKEAWAY:

• Nearly 1 in 4 operations (15,741 of 63,385; 24.8%) were performed at low-volume centers. Median overall survival was 33 months at high-volume centers vs 24.7 months at low-volume centers. After adjustment, treatment at high-volume centers was associated with improved survival (hazard ratio, 0.80; P < .001) compared with treatment at low-volume centers.
• Mortality rates at low-volume centers were roughly twice as high at both 30 days (5.12% vs 2.38%; P < .001) and 90 days (9.33% vs 5.16%; P < .001).
• R0 resection rates were lower at low-volume centers than at high-volume centers (78% vs 82.6%; P < .001). Patients treated at low-volume centers also had longer hospital stays (11.87 vs 9.88 days; P < .001) and higher 30-day readmission rates (8.61% vs 7.85%; P = .002).
• Black and Hispanic patients made up a larger proportion of those treated at low-volume centers vs high-volume centers (Black patients, 13.16% vs 9.71%; Hispanic patients, 8.44% vs 5.59%; P < .001 for both). Findings were similar for patients from neighborhoods in the lowest quartile of median income or educational attainment. Patients treated at low-volume centers lived closer to the facility than those treated at high-volume centers (median distance, 9.9 vs 24.2 miles).

IN PRACTICE:

The findings showed that minority and socioeconomically disadvantaged patients are disproportionately treated at low-volume centers — with “devastating consequences” for their outcomes, the authors of the study wrote. “Significant investment from all interested parties, including insurers, high-volume facilities, and community organizations, is needed to improve equal access to high-volume facilities and address these disparities,” they concluded.

SOURCE:

The study, led by Noah S. Brown, MD, University of Utah Health, Salt Lake City, was published online in the Journal of the American College of Surgeons.

LIMITATIONS:

The percentage of operations performed at low-volume centers was likely underestimated, as high-volume institutions were more likely to be accredited by the Commission on Cancer and report data to the National Cancer Database. Socioeconomic data were limited to zip code-level information, which may not fully capture individual patient circumstances.

DISCLOSURES:

The authors did not disclose any funding information and declared having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.