PMID- 34932991 OWN - NLM STAT- MEDLINE DCOM- 20220523 LR - 20220715 IS - 1097-6779 (Electronic) IS - 0016-5107 (Linking) VI - 95 IP - 6 DP - 2022 Jun TI - Definition of a hospital volume threshold to optimize outcomes after drainage of pancreatic fluid collections with lumen-apposing metal stents: a nationwide cohort study. PG - 1158-1172 LID - S0016-5107(21)01885-X [pii] LID - 10.1016/j.gie.2021.12.006 [doi] AB - BACKGROUND AND AIMS: There is increasing interest in expanding the use of lumen-apposing metal stents (LAMSs) in patients with pancreatic fluid collections (PFCs). The aim of this study was to determine whether there is a hospital volume threshold for which patient outcomes could be optimized. METHODS: Data from a large multicenter series of patients with PFCs treated with LAMSs were retrieved. Rate of adverse events (AEs) was the primary outcome. Multivariable models with restricted cubic splines were used to identify a hospital volume threshold by plotting hospital volume against the log odds ratio (OR) of AE rate. Propensity score matching was applied to obtain 2 well-balanced groups according to hospital volume, and univariate/multivariate logistic regression analysis was performed to identify significant predictors of AEs. RESULTS: Overall, 516 patients were included. Increasing hospital volume was associated with a reduced AE rate (P = .03), and the likelihood of experiencing an AE declined as hospital volume increased up to 15 cases. After propensity score matching, 175 patients in the high-volume (>15 cases) and 132 in the low-volume hospital group were compared. Overall, 41 AEs were observed (13.3%), of which 14 (8%) and 27 (20.4%) occurred at high-volume and low-volume centers, respectively (P = .001). Severe and fatal events were observed more frequently in low-volume centers (6% vs 1.7% and 2.2% vs 0%, respectively; P = .05). In multivariate analysis, main pancreatic duct injury (OR, 2.62; 95% confidence interval [CI], 1.26-4.67; P = .02), presence of abnormal vessels (OR, 2.93; 95% CI, 1.41-5.02; P = .006), and institutional experience (OR, 2.95; 95% CI, 1.48-5.90; P = .002) were significant predictors of AEs. CONCLUSIONS: With 15 procedures representing the minimum number of cases associated with the lowest risk for postprocedural AEs, hospital volume is associated with improved outcomes. (Clinical trial registration number: NCT03903523.). CI - Copyright (c) 2022 American Society for Gastrointestinal Endoscopy. Published by Elsevier Inc. All rights reserved. FAU - Facciorusso, Antonio AU - Facciorusso A AD - Gastroenterology Unit, Department of Medical and Surgical Sciences, University of Foggia, Foggia, Italy; Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy. FAU - Amato, Arnaldo AU - Amato A AD - Department of Gastroenterology, Valduce Hospital, Como, Italy. FAU - Crino, Stefano Francesco AU - Crino SF AD - Gastroenterology and Digestive Endoscopy Unit, The Pancreas Institute, G.B. Rossi University Hospital, Verona, Italy. FAU - Sinagra, Emanuele AU - Sinagra E AD - Gastroenterology and Endoscopy Unit, Fondazione Istituto G. Giglio, Contrada Pietrapollastra Pisciotto, Cefalu, Italy. FAU - Maida, Marcello AU - Maida M AD - Gastroenterology and Endoscopy Unit, S. Elia-Raimondi Hospital, Caltanissetta, Italy. FAU - Fugazza, Alessandro AU - Fugazza A AD - Digestive Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, Milano, Italy. FAU - Binda, Cecilia AU - Binda C AD - Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, Forli-Cesena, Italy. FAU - Coluccio, Chiara AU - Coluccio C AD - Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, Forli-Cesena, Italy. FAU - Repici, Alessandro AU - Repici A AD - Digestive Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, Milano, Italy; Department of Biomedical Sciences, Humanitas University, Rozzano, Italy. FAU - Anderloni, Andrea AU - Anderloni A AD - Digestive Endoscopy Unit, Humanitas Clinical and Research Center-IRCCS, Milano, Italy. FAU - Tarantino, Ilaria AU - Tarantino I AD - Endoscopy Service, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy. FAU - Fabbri, Carlo AU - Fabbri C AD - Gastroenterology and Digestive Endoscopy Unit, Forli-Cesena Hospitals, Forli-Cesena, Italy. CN - i-EUS Group LA - eng SI - ClinicalTrials.gov/NCT03903523 PT - Journal Article PT - Multicenter Study DEP - 20211218 PL - United States TA - Gastrointest Endosc JT - Gastrointestinal endoscopy JID - 0010505 SB - IM CIN - Gastrointest Endosc. 2022 Jun;95(6):1173-1175. PMID: 35461683 MH - Cohort Studies MH - *Drainage/methods MH - Endosonography/methods MH - Hospitals MH - Humans MH - *Pancreatic Diseases/etiology/surgery MH - Retrospective Studies MH - Stents/adverse effects MH - Treatment Outcome FIR - Ramai, Daryl IR - Ramai D FIR - Mutignani, Massimiliano IR - Mutignani M FIR - Forti, Edoardo IR - Forti E FIR - Arcidiacono, Paolo Giorgio IR - Arcidiacono PG FIR - Petrone, Maria Chiara IR - Petrone MC FIR - Conte, Elisabetta IR - Conte E FIR - Di Mitri, Roberto IR - Di Mitri R FIR - Berretti, Debora IR - Berretti D FIR - De Nucci, Germana IR - De Nucci G FIR - Macchiarelli, Raffaele IR - Macchiarelli R FIR - Lovera, Mauro IR - Lovera M FIR - Attili, Fabia IR - Attili F FIR - Brancaccio, Mario Luciano IR - Brancaccio ML FIR - Redaelli, Alessandro IR - Redaelli A FIR - Tasini, Enrico IR - Tasini E FIR - Ballare, Marco IR - Ballare M FIR - Coppola, Franco IR - Coppola F FIR - Leone, Nicola IR - Leone N FIR - Cugia, Luigi IR - Cugia L FIR - Grassia, Roberto IR - Grassia R FIR - Sbrancia, Monica IR - Sbrancia M FIR - Togliani, Thomas IR - Togliani T FIR - Lisotti, Andrea IR - Lisotti A FIR - Fusaroli, Pietro IR - Fusaroli P FIR - De Angelis, Claudio IR - De Angelis C FIR - Cipolletta, Fabio IR - Cipolletta F FIR - Manno, Mauro IR - Manno M FIR - Badas, Roberta IR - Badas R FIR - Pollino, Valeria IR - Pollino V FIR - Camellini, Lorenzo IR - Camellini L FIR - Bernardoni, Laura IR - Bernardoni L EDAT- 2021/12/22 06:00 MHDA- 2022/05/24 06:00 CRDT- 2021/12/21 20:12 PHST- 2021/10/01 00:00 [received] PHST- 2021/12/11 00:00 [accepted] PHST- 2021/12/22 06:00 [pubmed] PHST- 2022/05/24 06:00 [medline] PHST- 2021/12/21 20:12 [entrez] AID - S0016-5107(21)01885-X [pii] AID - 10.1016/j.gie.2021.12.006 [doi] PST - ppublish SO - Gastrointest Endosc. 2022 Jun;95(6):1158-1172. doi: 10.1016/j.gie.2021.12.006. Epub 2021 Dec 18.