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dc.contributor.authorNymo, Linn Såve
dc.contributor.authorKleive, Dyre
dc.contributor.authorWaardal, Kim
dc.contributor.authorBringeland, Erling Audun
dc.contributor.authorSøreide, Jon Arne
dc.contributor.authorLabori, Knut Jørgen
dc.contributor.authorMortensen, Kim Erlend
dc.contributor.authorSøreide, Kjetil
dc.contributor.authorLassen, Kristoffer
dc.date.accessioned2021-01-29T10:59:21Z
dc.date.available2021-01-29T10:59:21Z
dc.date.created2020-11-29T13:53:38Z
dc.date.issued2020
dc.identifier.citationBJS Open. 2020, 4 (5), 904-913.en_US
dc.identifier.issn2474-9842
dc.identifier.urihttps://hdl.handle.net/11250/2725330
dc.description.abstractBackground Centralization of pancreatic surgery is currently called for owing to superior outcomes in higher‐volume centres. Conversely, organizational and patient concerns speak for a moderation in centralization. Consensus on the optimal balance has not yet been reached. This observational study presents a volume–outcome analysis of a complete national cohort in a health system with long‐standing centralization. Methods Data for all pancreatoduodenectomies in Norway in 2015 and 2016 were identified through a national quality registry and completed through electronic patient journals. Hospitals were dichotomized (high‐volume (40 or more procedures/year) or medium–low‐volume). Results Some 394 procedures were performed (201 in high‐volume and 193 in medium–low‐volume units). Major postoperative complications occurred in 125 patients (31·7 per cent). A clinically relevant postoperative pancreatic fistula occurred in 66 patients (16·8 per cent). Some 17 patients (4·3 per cent) died within 90 days, and the failure‐to‐rescue rate was 13·6 per cent (17 of 125 patients). In multivariable comparison with the high‐volume centre, medium–low‐volume units had similar overall complication rates, lower 90‐day mortality (odds ratio 0·24, 95 per cent c.i. 0·07 to 0·82) and no tendency for a higher failure‐to‐rescue rate. Conclusion Centralization beyond medium volume will probably not improve on 90‐day mortality or failure‐to‐rescue rates after pancreatoduodenectomy.en_US
dc.language.isoengen_US
dc.publisherBritish Journal of Surgery Society, Wileyen_US
dc.rightsNavngivelse-Ikkekommersiell 4.0 Internasjonal*
dc.rights.urihttp://creativecommons.org/licenses/by-nc/4.0/deed.no*
dc.titleCentralizing a national pancreatoduodenectomy service: striking the right balanceen_US
dc.typePeer revieweden_US
dc.typeJournal articleen_US
dc.description.versionpublishedVersionen_US
dc.source.pagenumber904-913en_US
dc.source.volume4en_US
dc.source.journalBJS Openen_US
dc.source.issue5en_US
dc.identifier.doi10.1002/bjs5.50342
dc.identifier.cristin1853762
dc.description.localcode© 2020 The Authors. BJS Open published by John Wiley & Sons Ltd on behalf of British Journal of Surgery Society. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes.en_US
cristin.ispublishedtrue
cristin.fulltextoriginal
cristin.qualitycode1


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Navngivelse-Ikkekommersiell 4.0 Internasjonal
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