Hospital surgical volume, perioperative transfusion, and 30-day mortality after pancreatic surgery: a nationwide population-based retrospective cohort study in South Korea.

PURPOSE: We evaluated national trends in 30-day mortality following pancreatic surgery and the factors associated with 30-day mortality in South Korea, with special attention to hospital surgical volume and perioperative transfusion as perioperative risk markers. METHODS: We performed a retrospective, population-based study using Korean National Health Insurance Service data. Adults who underwent pancreatic surgery during 2012-2020 were included (n = 40,937). The annual 30-day mortality rates were described overall and stratified by year, age, sex, and pancreatic surgical procedure. We analyzed the associations between hospital surgical volume, perioperative transfusion, and 30-day mortality. RESULTS: The annual number of pancreatic surgeries increased from 4,055 in 2012 to 5,278 in 2020, whereas 30-day mortality remained stable (1.2%-1.9%, P-trend = 0.401). Mortality was lowest in high-volume hospitals (1.0%) and highest in the lowest-volume hospitals (5.9%). Perioperative transfusion and greater transfusion volume were strongly associated with increased 30-day mortality; both were more frequent and of greater quantities in lower-volume hospitals. Across the transfusion strata, a higher hospital surgical volume was consistently associated with lower mortality. In multivariable analyses, lower hospital volume and greater transfusion volume were independently associated with increased 30-day mortality, demonstrating a clear volume-outcome gradient and dose-response relationship with the transfusion amount. CONCLUSION: Despite the increasing surgical volume nationwide, the 30-day mortality after pancreatic surgery in South Korea remained unchanged. Lower hospital volume and perioperative transfusion independently predicted increased 30-day mortality. Given lower transfusion rates in high-volume hospitals, these findings support centralizing pancreatic surgery in specialized centers and highlight the importance of optimized perioperative management.