Indice
Descrizione indicatore
L’indicatore ci consente di calcolare il numero di interventi chirurgici per tumori maligni al pancreas eseguiti in un anno in una struttura ospedaliera.
Questo numero rappresenta il "volume" di interventi (indicatore di "
volume").
Come si legge
L’indicatore si riferisce al grado di "
competenza" e di "
sicurezza" delle cure prestate.
Più alto è il numero di interventi chirurgici per tumori maligni al pancreas eseguiti in una struttura ospedaliera, maggiore è il grado di esperienza della struttura stessa e la sicurezza del trattamento offerto.
Fonte del dato
Programma Nazionale Esiti 2024.
Confronto tra strutture calcolato su dati 2023.
Nota bene: per tener conto di errori nell’attribuzione di condizioni/interventi a singoli ospedali, sono state escluse dalle analisi tutte le strutture con volumi di attività molto bassi in relazione alla condizione considerata (volume di attività minimo
5 casi/anno).
Come riportato nel documento elaborato dal PNE, la definizione dell’esposizione sulla base dei volumi della struttura piuttosto che dell’unità operativa potrebbe essere soggetta a misclassificazione.
Valutazione istituzionale
Il Gruppo di lavoro del Programma Nazionale Esiti ha stabilito che un ospedale dovrebbe eseguire
almeno 50 interventi all’anno per tumore maligno al pancreas.
Il semaforo è calcolato sulla base del seguente documento ufficiale:
Consulta le strutture sanitarie che effettuano in un anno il maggior numero di interventi chirurgici per tumori al pancreas
Altre informazioni
Codici ICD-9-CM selezionati
Sono inclusi tutti i ricoveri, in regime ordinario, con diagnosi principale o secondaria di tumore maligno del pancreas (ICD-9-CM 157) ed intervento principale o secondario di resezione o asportazione radicale del pancreas (ICD-9-CM 52.5, 52.6, 52.7).
Il volume di ricoveri per interventi chirurgici è calcolato su base annuale, riferito all’anno di dimissione del ricovero.
Fonti scientifiche
- Gooiker GA, Van Gijn W, Wouters MW, Post PN, Van de Velde CJ, Tollenaar RA; Signalling committee cancer of the Dutch cancer society. Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery. Br J surg 2011;98(4):485-94.
- Hata T, Motoi F, Ishida M et al. Effect of Hospital Volume on Surgical Outcomes After Pancreaticoduodenectomy: A systematic Review and Meta-analysis. Ann surg 2016;263(4):664-72. doi: 10.1097/sLA.0000000000001437.
- Van Heek NT, Kuhlmann KF, Scholten RJ et al. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann surg 2005;242(6):781-88; discussion 788-90.
- Gruen RL, Pitt V, Green S, Parkhill A, Campbell D, Jolley D. The effect of provider case volume on cancer mortality: systematic review and meta-analysis. CA Cancer J Clin 2009;59(3):192-211.
- Killeen SD, O’Sullivan MJ, Coffey JC, Kirwan WO, Redmond HP. Provider volume and outcomes for oncological procedures. Br J Surg 2005;92(4):389-402.
- Holscher AH, Metzger R, Brabender J, Vallbohmer D, Bollschweiler E. High-volume centers - effect of caseload on outcome in cancer surgery. onkologie 2004; 27(4):412-16.
- Weitz J, Koch M, Friess H, Büchler MW. Impact of volume and specialization for cancer sugery. Dig surg 2004;21(4):253-61.
- Gandjour A, Bannerberg A, Lauterbach KW. Threshold volumes associated with higher survival in health care. Med care 2003;41(10):1129-41.
- Pla R, Pons JMV, Gonzalez JR, Borras JM. Hay niveles assistenciales en cirurgia oncologica? Los que mas hacen, lo hacen mejor? informe sobre la relacion en- tre volumen de procedimientos y resultados en cirurgia oncologica. Barcelona, Agència d’Avaluaciò de Tecnologia i Recerca Mèdiques, catsalut, Department de sanitat i seguretat social, Generalitat de catalunya, 2003; pp. 1-59.
- Halm EA, Lee C, Chassin MR. Is volume related to outcome in health care? A systematic review and methodologic critique of the literature. Ann intern Med 2002:137(6):511-20.
- Dudley RA, Johansen KL, Brand R, Rennie DJ, Milstein A. Selective referral to high-volume hospitals: estimating potentially avoidable deaths. JAMA 2000; 283(9):1159-66.
- De Rooij T, Lu M, Steen W et al. A systematic review and metaanalysis of minimally invasive versus open pancreatoduodenectomy. HPB 2016;18(s1):e37. doi: 10.1016/j.hpb.2016.02.094.
- Keck T, Makowiec F, Adam U, Hopt UT. Does hospital volume have influence on the results of pancreatic surgery? Zentralbl Chir 2007;132(1):26-31.
- Bachmann MO, Alderson D, Peters TJ et al. Influence of specialization on the management and outcome of patients with pancreatic cancer. Br J surg 2003;90(2):171-77.
- Balzano G, Zerbi A, Capretti G, Rocchetti S, Capitanio V, Di carlo V. Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy. Br J surg 2008;95(3): 357-62.
- Birkmeyer JD, Finlayson SR, Tosteson AN, Sharp SM, Warshaw Al, Fisher ES. Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery 1999;125(3):250-56.
- Birkmeyer JD, Warshaw Al, Finlayson SR, Grove MR, Tosteson AN. Relationship between hospital volume and late survival after pancreaticoduodenectomy. Surgery 1999;126(2):178-83.
- De Wilde RF, Besselink MG, Van der Tweel I et al. Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J surg 2012;99(3):404-10.
- Edge SB, Schmieg RE Jr, Rosenlof lK, Wilhelm MC. Pancreas cancer resection outcome in American university centers in 1989-1990. cancer 1993;71(11):3502-08.
- Eppsteiner RW, Csikesz NG, McPhee JT, Tseng JF, Shah SA. Surgeon volume impacts hospital mortality for pancreatic resection. Ann surg 2009;249(4):635-40.
- Finlayson EV, Glasgow RE, Mulvihill SJ. Hospital volume in uences outcome in patients undergoing pancreatic resection for cancer. West J Med 1996;165(5):294-300.
- Gooiker GA, lemmens Ve, Besselink MG et al. Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br J surg 2014;101(8):1000-05.
- Gordon TA, Bowman HM, Tielsch JM, Bass EB, Burleyson GP, Cameron Jl. State-wide regionalization of pancreaticoduodenectomy and its effect on in-hospital mortality. Ann surg 1998;228(1):71-78.
- Gouma dJ, van Geenen RC, Van Gulik TM et al. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann surg 2000;232(6):786-95.
- Ho V, Heslin MJ. Effect of hospital volume and experience on inhospital mortality for pancreaticoduodenectomy. Ann surg 2003;237(4):509-14.
- Hollenbeck BK, Dunn Rl, Miller DC, Daignault S, Taub DA,Wei JT. Volume-based referral for cancer surgery: informing the debate. J clin oncol 2007;25(1):91-96.
- Hutter MM, Glasgow RE, Mulvihill SJ. Does the participation of a surgical trainee adversely impact patient outcomes? A study of major pancreatic resections in california. surgery 2000;128(2):286-92.
- Hyder O, Dodson RM, Nathan H et al. Influence of patient, physician, and hospital factors on 30-day readmission following pancreatoduodenectomy in the United states. JAMA surg 2013;148(12):1095-102.
- Schneider EB, Hyder O, Wolfgang CL et al. Provider versus patient factors impacting hospital length of stay after pancreaticoduodenectomy. surgery 2013; 154(2):152-61.
- Simunovic M, To T, Theriault M, Langer B. Relation between hospital surgical volume and outcome for pancreatic resection for neoplasm in a publicly funded health care system. cMAJ1999;160(5):643-48.
- Sosa JA, Bowman HM, Gordon TA et al. Importance of hospital volume in the overall management of pancreatic cancer. Ann surg 1998;228(3):429-38.
- Swan RZ, Niemeyer DJ, Seshadri RM et al. The impact of regionalization of pancreaticoduodenectomy for pancreatic cancer in north carolina since 2004. Am surg 2014;80(6):561-66.
- Teh SH, Diggs BS, Deveney CW, Sheppard BC. Patient and hospital characteristics on the variance of perioperative outcomes for pancreatic resection in the United States: a plea for outcome-based and not volume-based referral guidelines. Arch surg 2009;144(8):713-21.
- Topal B, Van de Sande S, Fleuws S, Penninckx F. Effect of centralization of pancreaticoduodenectomy on nationwide hospital mortality and length of stay. Br J surg 2007;94(11):1377-81.
- Van Heek NT, Kuhlmann KF, Scholten RJ et al. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the netherlands. Ann surg 2005;242(6):781-90.
- Van Oost FJ, Luiten EJ, Van De Poll-Franse LV, Coebergh JW, Van den Eijnden-Van Raaij AJ. Outcome of surgical treatment of pancreatic, peri-ampullary and ampullary cancer diagnosed in the south of the Netherlands: a cancer registry based study. eur J surg oncol 2006;32(5):548-52.
- Wade TP, Halaby IA, Stapleton DR, Virgo KS, Johnson fE. Population-based analysis of treatment of pancreatic cancer and Whipple resection: department of defense hospitals, 1989-1994. Surgery 1996;120(4):680-85; discussion 686-87.
- Yoshioka R, Yasunaga H, Hasegawa K et al. Impact of hospital volume on hospital mortality, length of stay and total costs after pancreaticoduodenectomy. Br J surg 2014;101(5):523-29.