Regional versus metropolitan pancreaticoduodenectomy mortality in Australia

• Published in: ANZ journal of surgery Vol. 89; no. 12; pp. 1582 - 1586
• Main Authors: Davis, Sean S., Babidge, Wendy J., Kiermeier, Andreas, Maddern, Guy J.
• Format: Journal Article
• Language: English
• Published: Melbourne John Wiley & Sons Australia, Ltd 01-12-2019; Blackwell Publishing Ltd
• Subjects: general surgery; hepatopancreaticobiliary surgery; Hospitals; Identification methods; Mortality; pancreas; Pancreaticoduodenectomy; perioperative mortality; Population studies; Regional analysis; regional versus metropolitan; Regression analysis; Statistical analysis; Australia; general surgery; perioperative mortality; hepatopancreaticobiliary surgery; regional versus metropolitan; pancreas
• ISSN: 1445-1433; 1445-2197
• DOI: 10.1111/ans.15336

Background
This retrospective, population‐based cohort study aims to determine if differences in the regional distribution of procedures or variation in regional mortality contributes to the variable pancreaticoduodenectomy (PD) mortality between Australian states and territories.
Methods
De‐identified procedural data from public hospitals between 1 July 2005 and 30 June 2015 from the Australian Institute of Health and Welfare were analysed. The regional distribution of procedures and variation in perioperative mortality rate (POMR) were investigated in New South Wales (NSW), Victoria and Queensland (QLD) using logistic regression analysis.
Results
NSW performed the highest proportion of city‐based procedures (93.8%) while QLD performed the highest proportion of regional procedures (15.3%). QLD demonstrated the lowest city mortality (1.9%) and lowest POMR overall (2.0%). City, regional and state‐wide mortality was highest in NSW (5.0%, 8.4% and 5.3%). No significant difference in POMR was demonstrated between regional and city hospitals in each of the states (P = 0.46) or across all states (P = 0.50).
Conclusion
This study demonstrates comparable regional PD distribution across Australia. The difference in PD POMR between city and regional areas was not found to be statistically significant. NSW exhibited the highest city, regional and overall PD POMR, potentially warranting further investigation.
This retrospective, population‐based cohort study aims to determine if differences in the regional distribution of procedures or variation in regional mortality contributes to the variable pancreaticoduodenectomy outcomes between states and territories mortality in Australia.