{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,5]],"date-time":"2026-08-05T03:45:07Z","timestamp":1785901507259,"version":"3.56.0"},"reference-count":23,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T00:00:00Z","timestamp":1785715200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Hepato Biliary Pancreat"],"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Background\/Purpose<\/jats:title>\n                    <jats:p>This study evaluated the association between institutional advanced hepatobiliary\u2010pancreatic (HBP) surgical volume and operative mortality for pancreaticoduodenectomy (PD) and advanced hepatectomy using data from the Japanese National Clinical Database.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>Patients undergoing PD or advanced hepatectomy between 2018 and 2021 were identified. Hospital volume was defined as the mean annual number of advanced HBP procedures performed at each institution. Volume\u2010mortality associations were assessed using thin\u2010plate spline regression with hospital volume as a continuous variable, followed by categorical analyses using four predefined groups (\u2264\u200919, 20\u201329, 30\u201349, and \u2265\u200950 cases\/year). The primary outcome was the operative mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We analyzed 47\u2009088 patients undergoing PD and 27\u2009358 undergoing hepatectomy. Mortality decreased with increasing institutional advanced HBP surgical volume for both procedures and plateaued at approximately 50 annual procedures. Compared with 30\u201349\u2010case institutions, \u2264\u200919\u2010case hospitals had significantly higher adjusted mortality for PD and hepatectomy, whereas \u2265\u200950\u2010case hospitals had significantly lower mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Higher institutional advanced HBP surgical volume was associated with lower operative mortality for both procedures. Although both procedures appeared to achieve stable outcomes at similarly high institutional volumes, their volume\u2013mortality curves differed in shape, suggesting the value of incorporating procedure\u2010specific considerations into future quality assessment frameworks.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/jhbp.70168","type":"journal-article","created":{"date-parts":[[2026,8,3]],"date-time":"2026-08-03T09:18:10Z","timestamp":1785748690000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Hospital Volume and Operative Mortality in Pancreaticoduodenectomy and Hepatectomy: Analysis of the National Clinical Database in Japan"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7419-5638","authenticated-orcid":false,"given":"Yoshitaro","family":"Shindo","sequence":"first","affiliation":[{"name":"Department of Gastroenterological, Breast, and Endocrine Surgery Yamaguchi University Graduate School of Medicine  Yamaguchi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0052-0332","authenticated-orcid":false,"given":"Hideki","family":"Endo","sequence":"additional","affiliation":[{"name":"Department of Healthcare Quality Assessment, Graduate School of Medicine The University of Tokyo  Tokyo Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3337-7595","authenticated-orcid":false,"given":"Hiroyuki","family":"Yamamoto","sequence":"additional","affiliation":[{"name":"Department of Healthcare Quality Assessment, Graduate School of Medicine The University of Tokyo  Tokyo Japan"},{"name":"Department of Health Data Science Tohoku University Graduate School of Medicine  Sendai Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hidenori","family":"Takahashi","sequence":"additional","affiliation":[{"name":"Department of Gastroenterological, Breast, and Endocrine Surgery Yamaguchi University Graduate School of Medicine  Yamaguchi Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5263-3286","authenticated-orcid":false,"given":"Shigeru","family":"Marubashi","sequence":"additional","affiliation":[{"name":"The Japanese Society of Hepato\u2010Biliary\u2010Pancreatic Surgery  Tokyo Japan"},{"name":"Department of Hepato\u2010Biliary\u2010Pancreatic and Transplant Surgery Fukushima Medical University  Fukushima Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3246-557X","authenticated-orcid":false,"given":"Atsushi","family":"Nanashima","sequence":"additional","affiliation":[{"name":"Project Management Subcommittee The Japanese Society of Gastroenterological Surgery  Tokyo Japan"},{"name":"Division of Hepato\u2010Biliary\u2010Pancreas Surgery, Department of Surgery University of Miyazaki Faculty of Medicine  Miyazaki Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5520-8114","authenticated-orcid":false,"given":"Itaru","family":"Endo","sequence":"additional","affiliation":[{"name":"Project Management Subcommittee The Japanese Society of Gastroenterological Surgery  Tokyo Japan"},{"name":"Department of Gastroenterological Surgery Yokohama City University Graduate School of Medicine  Yokohama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8600-1199","authenticated-orcid":false,"given":"Hideki","family":"Ueno","sequence":"additional","affiliation":[{"name":"Database Committee The Japanese Society of Gastroenterological Surgery  Tokyo Japan"},{"name":"Department of Surgery National Defense Medical College  Saitama Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7173-7945","authenticated-orcid":false,"given":"Ken","family":"Shirabe","sequence":"additional","affiliation":[{"name":"The Japanese Society of Gastroenterological Surgery  Tokyo Japan"},{"name":"Department of Hepatobiliary and Pancreatic Surgery Gunma University Graduate School of Medicine  Gunma Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6196-8643","authenticated-orcid":false,"given":"Masafumi","family":"Nakamura","sequence":"additional","affiliation":[{"name":"The Japanese Society of Hepato\u2010Biliary\u2010Pancreatic Surgery  Tokyo Japan"},{"name":"Department of Surgery and Oncology, Graduate School of Medical Sciences Kyushu University  Fukuoka 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