{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T04:45:30Z","timestamp":1791780330520,"version":"4.3.4"},"reference-count":23,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","license":[{"start":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T00:00:00Z","timestamp":1788912000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/ http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2026,11]]},"abstract":"<jats:sec>\n                    <jats:title>Objective:<\/jats:title>\n                    <jats:p>To identify modifiable hospital-level determinants of mortality after pancreas surgery and assess their cumulative protective effects through the development of a Hospital Resource Index (HRI) on a global scale.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Ninety-day mortality rates after pancreas surgery vary globally (2%\u201310%); however, institutional factors affecting mortality remain poorly understood. Although caseload volume has driven centralization policies in many health care systems, it is not fully explanatory, and the impact of specific modifiable structural and process-related hospital factors remains unclear.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We linked patient outcome data from the 2021 PancreasGroup.org global prospective cohort to hospital infrastructure data from the PancreasGroup.org global survey. Binary availability of 20 hospital-level factors was assessed. Factors significantly associated with mortality on univariable multilevel regression were combined into an additive HRI. Multivariable logistic regression evaluated associations between HRI and 90-day mortality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      Analyses included 2928 patients from 214 centers across 60 countries. Six hospital factors were significantly associated with lower mortality, including interventional radiology\/endoscopy availability, structured nutrition support, evidence-based practice adoption, staff training, equipment maintenance, and favorable nurse-patient ratios. Each additional HRI point was associated with 12% lower mortality odds (OR: 0.88, 95% CI: 0.81\u20130.95,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.001), independent of caseload volume (OR: 0.73,\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      =0.014, optimal cutoff 55 cases per year), country\u2019s development index, and patient and procedural characteristics. Patients treated at hospitals with all 6 HRI resources had 54% lower adjusted odds of 90-day mortality than those at hospitals with none (OR 0.46, 95% CI 0.30\u20130.70).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>The developed HRI showed cumulative protective effects on mortality after pancreas surgery, with volume remaining independently protective in the adjusted model, providing actionable targets for resource allocation to enhance pancreas surgery outcomes beyond centralization globally.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/sla.0000000000007196","type":"journal-article","created":{"date-parts":[[2026,9,9]],"date-time":"2026-09-09T10:19:47Z","timestamp":1788949187000},"page":"985-992","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Hospital-Level Determinants of Mortality After Pancreas Surgery"],"prefix":"10.1097","volume":"284","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6279-3689","authenticated-orcid":false,"given":"Camila","family":"Hidalgo Salinas","sequence":"first","affiliation":[{"name":"Department of Surgery, NYU Grossman School of Medicine, New York, NY"},{"name":"Nuffield Department of Primary Care Health Sciences, Centre for Evidence-Based Medicine, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK"},{"name":"Department for Continuing Education, University of Oxford, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Pascale","family":"Tinguely","sequence":"additional","affiliation":[{"name":"Department of HPB Surgery and Liver Transplant, Royal Free Hospital NHS Foundation Trust, London, UK"},{"name":"Department of Visceral and Transplantation Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0898-3270","authenticated-orcid":false,"given":"Dimitri A.","family":"Raptis","sequence":"additional","affiliation":[{"name":"Organ Transplant Center of Excellence, King Faisal Specialist Hospital and Research Centre, Riyadh, Saudi Arabia"},{"name":"Faculty of Medicine, Alfaisal University, Riyadh, Saudi Arabia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sterre","family":"van Herwijnen","sequence":"additional","affiliation":[{"name":"Department of Surgery, NYU Grossman School of Medicine, New York, NY"},{"name":"Faculty of Medicine, Vrije Universiteit Amsterdam, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ammar A.","family":"Javed","sequence":"additional","affiliation":[{"name":"Department of Surgery, NYU Grossman School of Medicine, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2418-2091","authenticated-orcid":false,"given":"Rafael","family":"Perera","sequence":"additional","affiliation":[{"name":"Nuffield Department of Primary Care Health Sciences, Centre for Evidence-Based Medicine, University of Oxford, Radcliffe Observatory Quarter, Oxford, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6295-1085","authenticated-orcid":false,"given":"Cristina R.","family":"Ferrone","sequence":"additional","affiliation":[{"name":"Department of Surgery, Cedars-Sinai Medical Center, Los Angeles, CA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0000-5817-6146","authenticated-orcid":false,"given":"Christopher L.","family":"Wolfgang","sequence":"additional","affiliation":[{"name":"Department of Surgery, NYU Grossman School of Medicine, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe K.","family":"Fusai","sequence":"additional","affiliation":[{"name":"Department of Visceral and Transplantation Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland"},{"name":"Division of Surgery and Interventional Sciences, University College London, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"name":"PancreasGroup.org Collaborative","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,9,9]]},"reference":[{"key":"R1-20261012","doi-asserted-by":"crossref","first-page":"304","DOI":"10.1016\/j.jss.2018.05.075","article-title":"Mortality after pancreaticoduodenectomy: assessing early and late causes of patient death","volume":"231","author":"Narayanan","year":"2018","journal-title":"J Surg 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meta-analysis","volume":"172","author":"Ratnayake","year":"2022","journal-title":"Surgery"},{"key":"R8-20261012","doi-asserted-by":"crossref","first-page":"904","DOI":"10.1002\/bjs5.50342","article-title":"Centralizing a national pancreatoduodenectomy service: striking the right balance","volume":"4","author":"Nymo","year":"2020","journal-title":"BJS Open"},{"key":"R9-20261012","doi-asserted-by":"crossref","first-page":"339","DOI":"10.1001\/jama.2020.2953","article-title":"Centralization of high-risk surgery in the US: feasible solution or more trouble than it is worth?","volume":"324","author":"Sheetz","year":"2020","journal-title":"JAMA"},{"key":"R10-20261012","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.4240\/wjgs.v13.i10.1122","article-title":"Review of minimally invasive pancreas surgery and opinion on its incorporation into low volume and resource poor centres","volume":"13","author":"Cawich","year":"2021","journal-title":"World J Gastrointest 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