Pancreatoduodenectomy in a public versus private teaching hospital is comparable with some minor variations

Terence C. Chua, Anubhav Mittal, Chris Nahm, Thomas J. Hugh, Jenny Arena, Anthony J. Gill, Jaswinder S. Samra

Research output: Contribution to journalArticleResearchpeer-review

Abstract

Background: The impact of the public and private hospital systems on major abdominal operations that are demanding on clinical resources, such as pancreatic surgery, has not been explored in an Australian setting. This study examines the perioperative outcome of patients undergoing pancreatoduodenectomy (PD) at a major public and private hospital. Methods: Patients undergoing PD between January 2004 and October 2015 were classified based on their health insurance status and location of where the surgery was performed. Clinical variables relating to perioperative outcome were retrieved and compared using univariate and multivariate analyses. Results: Four hundred and twenty patients underwent PD of whom 232 patients (55%) were operated on in the private hospital. Overall, there was no difference in morbidity and mortality in the public versus the private hospital. However, there were variations in public versus private hospital, this included longer duration of surgery (443 min versus 372 min; P < 0.001), increased estimated blood loss (683 mL versus 506 mL; P < 0.001) and more patients requiring perioperative blood transfusion (25% versus 13%; P = 0.001). Of the 10 complications compared, post-operative bleeding was higher in the private hospital (11% versus 5%; P = 0.051) and intra-abdominal collections were more common in the public hospital (11% versus 5%; P = 0.028). Independent predictive factors for major complications were American Society of Anesthesiologists score (odds ratio (OR) = 1.91; P = 0.050), patients requiring additional visceral resection (OR = 3.36; P = 0.014) and post-operative transfusion (OR = 3.37; P < 0.001). The hospital type (public/private) was not associated with perioperative outcome. Conclusion: Comparable perioperative outcomes were observed between patients undergoing PD in a high-volume specialized unit in both the public and private hospital systems.

LanguageEnglish
PagesE526-E531
Number of pages6
JournalANZ Journal of Surgery
Volume88
Issue number6
DOIs
Publication statusPublished - 1 Jun 2018

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Private Hospitals
Pancreaticoduodenectomy
Teaching Hospitals
Public Hospitals
Odds Ratio
Insurance Coverage
Health Insurance
Blood Transfusion
Health Status
Multivariate Analysis
Hemorrhage
Morbidity
Mortality

Keywords

  • Australia
  • complication
  • healthcare system
  • mortality
  • pancreatic cancer
  • pancreatoduodenectomy
  • private health insurance

Cite this

Chua, T. C., Mittal, A., Nahm, C., Hugh, T. J., Arena, J., Gill, A. J., & Samra, J. S. (2018). Pancreatoduodenectomy in a public versus private teaching hospital is comparable with some minor variations. ANZ Journal of Surgery, 88(6), E526-E531. https://doi.org/10.1111/ans.14191
Chua, Terence C. ; Mittal, Anubhav ; Nahm, Chris ; Hugh, Thomas J. ; Arena, Jenny ; Gill, Anthony J. ; Samra, Jaswinder S. / Pancreatoduodenectomy in a public versus private teaching hospital is comparable with some minor variations. In: ANZ Journal of Surgery. 2018 ; Vol. 88, No. 6. pp. E526-E531.
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abstract = "Background: The impact of the public and private hospital systems on major abdominal operations that are demanding on clinical resources, such as pancreatic surgery, has not been explored in an Australian setting. This study examines the perioperative outcome of patients undergoing pancreatoduodenectomy (PD) at a major public and private hospital. Methods: Patients undergoing PD between January 2004 and October 2015 were classified based on their health insurance status and location of where the surgery was performed. Clinical variables relating to perioperative outcome were retrieved and compared using univariate and multivariate analyses. Results: Four hundred and twenty patients underwent PD of whom 232 patients (55{\%}) were operated on in the private hospital. Overall, there was no difference in morbidity and mortality in the public versus the private hospital. However, there were variations in public versus private hospital, this included longer duration of surgery (443 min versus 372 min; P < 0.001), increased estimated blood loss (683 mL versus 506 mL; P < 0.001) and more patients requiring perioperative blood transfusion (25{\%} versus 13{\%}; P = 0.001). Of the 10 complications compared, post-operative bleeding was higher in the private hospital (11{\%} versus 5{\%}; P = 0.051) and intra-abdominal collections were more common in the public hospital (11{\%} versus 5{\%}; P = 0.028). Independent predictive factors for major complications were American Society of Anesthesiologists score (odds ratio (OR) = 1.91; P = 0.050), patients requiring additional visceral resection (OR = 3.36; P = 0.014) and post-operative transfusion (OR = 3.37; P < 0.001). The hospital type (public/private) was not associated with perioperative outcome. Conclusion: Comparable perioperative outcomes were observed between patients undergoing PD in a high-volume specialized unit in both the public and private hospital systems.",
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Chua, TC, Mittal, A, Nahm, C, Hugh, TJ, Arena, J, Gill, AJ & Samra, JS 2018, 'Pancreatoduodenectomy in a public versus private teaching hospital is comparable with some minor variations', ANZ Journal of Surgery, vol. 88, no. 6, pp. E526-E531. https://doi.org/10.1111/ans.14191

Pancreatoduodenectomy in a public versus private teaching hospital is comparable with some minor variations. / Chua, Terence C.; Mittal, Anubhav; Nahm, Chris; Hugh, Thomas J.; Arena, Jenny; Gill, Anthony J.; Samra, Jaswinder S.

In: ANZ Journal of Surgery, Vol. 88, No. 6, 01.06.2018, p. E526-E531.

Research output: Contribution to journalArticleResearchpeer-review

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AU - Nahm, Chris

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AU - Arena, Jenny

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AU - Samra, Jaswinder S.

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