The Impact of Hospital Mergers: Exploring the Importance of Flagship Designation, Hospital Volume, and Surgeon Volume on Perioperative Outcomes Following Whipple Procedure

Background and Objectives: The proportion of free-standing hospitals is rapidly declining in favor of healthcare systems. We aim to compare outcomes after pancreatoduodenectomy (PD) between hospital volume and surgeon volume within consolidated healthcare systems. Methods: Utilizing New York State's SPARCS database, we identified adults undergoing PD (2016–2019) at flagship (highest volume within a system) or non-flagship hospitals. Analysis compared 30- and 90-day outcomes by hospital and surgeon annual volume (hospital volume ≥ 20 vs < 20PD/yr and surgical volume ≥ 10 vs < 10PD/yr). We controlled for patient self-selection across surgeons and facilities using propensity-score matching. Results: Among 1633 patients, 68.8% were treated at flagship hospitals. Compared to patients treated at non-flagship hospitals, those at flagship hospitals had lower median postoperative length of stay (8-days vs. 10-days, p < 0.01), fewer transfusions (17% vs 29%, p < 0.01), other post-procedural (8.1% vs 12.6%, p = 0.02), and overall complications (53% vs 59%, p = 0.07). The lowest overall complications and length of stay (p < 0.05) were observed at high-volume hospitals regardless of surgeon volume. Conclusions: More favorable outcomes among pancreatoduodenectomy patient were observed at high-volume flagship hospitals. When planning a complex surgery, patients should be referred to the highest volume hospital within their healthcare system to optimize post-operative outcomes.