Kostalas M, et al. – This study aimed at determining the impact of centralisation on patients undergoing pancreatic head resections at a tertiary hepatobiliary (HPB) centre in the UK. Findings suggested that centralization led to a highly specialised, high quality service with resultant improvement in patient outcomes. The benefits of a multi–disciplinary and specialist HPB service resulted in a high volume, high quality unit with improved patient outcomes.

Methods

• From a prospectively maintained database, data on all patients undergoing pancreatic head resections was analysed from 1998 to 2014.
• Authors defined two specific time periods; these were the evolving unit phase (EU) from 1998 to 2009 and finally the established tertiary unit phase (TU) from 2010 to 2014.
• Analysis of peri–operative factors and post–operative outcomes was performed.

Results

• During the study period 395 resections were peformed.
• The volume of resections undertaken increased more than three–fold with an associated increase in case–complexity (p = 0.004) following establishment of the tertiary HPB unit.
• The TU phase indicated an increase in operating time in comparison with EU phase (p=>0.0005) whilst there appeared no significant difference in the rate of peri–operative transfusion, or in post–operative morbidity rates.
• Observations revealed a marked decline in the post–operative length of stay in the TU phase (p = 0.003) with a significantly higher proportion of patients being discharged within 9 days of their procedure (p=<0.0005).
• Authors also noticed a significant decline in 30–day post–operative mortality in the TU phase (0.5%) compared with the EU phase (3%) (p = 0.029).