Background and aims: There is increasing interest in expanding use of lumen-apposing metal stents (LAMSs) in patients with pancreatic fluid collections (PFCs). The aim of this study was to determine whether there is a hospital volume threshold for which patient outcomes could be optimized. Methods: Data from a large multicenter series of PFC patients treated with LAMSs were retrieved. Rate of adverse events (AEs) was the primary outcome. Multivariable models with restricted cubic splines were used to identify a hospital volume threshold by plotting hospital volume against the log odds ratio (OR) of AE rate. A propensity score matching was applied to obtain 2 well-balanced groups according to hospital volume and univariate/multivariate logistic regression analysis was performed to identify significant predictors of AEs. Results: Overall, 516 patients were included. Increasing hospital volume was associated with reduced AE rate (p=0.03) and the likelihood of experiencing an AE declined as hospital volume increased up to 15 cases. After propensity score matching, 175 patients in the high-volume (>15 cases) and 132 in the low-volume hospital group were compared. Overall, 41 AEs were observed (13.3%), of which 14 (8%) and 27 (20.4%) occurred at high-volume and low-volume centers, respectively (p=0.001). Severe and fatal events were observed more frequently in low-volume centers (6% vs 1.7% and 2.2% vs 0%, respectively; p=0.05). In multivariate analysis, main pancreatic duct injury (OR, 2.62; 95% CI, 1.26-4.67; p=0.02), presence of abnormal vessels (OR, 2.93; 95% CI, 1.41-5.02; p=0.006), and institutional experience (OR, 2.95; 95% CI, 1.48-5.90; p=0.002) were significant predictors of AEs. Conclusions: With 15 procedures representing the minimum number of cases associated with the lowest risk for postprocedural adverse events, hospital volume is associated with improved outcomes.
Definition of a hospital volume threshold to optimize outcomes after drainage of pancreatic fluid collections with lumen-apposing metal stents: a nationwide cohort study
Facciorusso, Antonio;
2021-01-01
Abstract
Background and aims: There is increasing interest in expanding use of lumen-apposing metal stents (LAMSs) in patients with pancreatic fluid collections (PFCs). The aim of this study was to determine whether there is a hospital volume threshold for which patient outcomes could be optimized. Methods: Data from a large multicenter series of PFC patients treated with LAMSs were retrieved. Rate of adverse events (AEs) was the primary outcome. Multivariable models with restricted cubic splines were used to identify a hospital volume threshold by plotting hospital volume against the log odds ratio (OR) of AE rate. A propensity score matching was applied to obtain 2 well-balanced groups according to hospital volume and univariate/multivariate logistic regression analysis was performed to identify significant predictors of AEs. Results: Overall, 516 patients were included. Increasing hospital volume was associated with reduced AE rate (p=0.03) and the likelihood of experiencing an AE declined as hospital volume increased up to 15 cases. After propensity score matching, 175 patients in the high-volume (>15 cases) and 132 in the low-volume hospital group were compared. Overall, 41 AEs were observed (13.3%), of which 14 (8%) and 27 (20.4%) occurred at high-volume and low-volume centers, respectively (p=0.001). Severe and fatal events were observed more frequently in low-volume centers (6% vs 1.7% and 2.2% vs 0%, respectively; p=0.05). In multivariate analysis, main pancreatic duct injury (OR, 2.62; 95% CI, 1.26-4.67; p=0.02), presence of abnormal vessels (OR, 2.93; 95% CI, 1.41-5.02; p=0.006), and institutional experience (OR, 2.95; 95% CI, 1.48-5.90; p=0.002) were significant predictors of AEs. Conclusions: With 15 procedures representing the minimum number of cases associated with the lowest risk for postprocedural adverse events, hospital volume is associated with improved outcomes.I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.
