Abstract
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Background: Burke et al. (2017) revealed that academic hospitals had lower patient mortality rates for common conditions compared to community-based hospitals. We conducted a retrospective study to compare survival of Stage I pancreatic cancer patients in academic versus community-based hospitals throughout the US. Methods: We identified 6,276 patients with single primary Stage IA or IB adenocarcinoma of the pancreas from the NCDB diagnosed from 2004-2012. We only included those who had a partial pancreatectomy, Whipple procedure, or no surgical intervention. In this subset, treatment was classified as none, chemotherapy, radiation, or chemoradiation; we examined the number of days from diagnosis to treatment. Unadjusted survival stratified by facility type was estimated with the Kaplan-Meier method; multivariable Cox regression was used to adjust for patient and facility level characteristics. Results: The log-rank test indicated that survival for patients who received treatment from an academic facility was significantly longer than those treated at a community-based facility (p < 0.001). After adjusting for patient and facility characteristics, however, survival was no longer significantly associated with facility type (p = 0.52). Holding all else constant, patients who underwent a surgical intervention had a lower risk of death (HR = 0.44, 95% CI: 0.40 to 0.48). Chemoradiation had a lower risk than both radiation (HR = 0.75, 95% CI: 0.65 to 0.86) and chemotherapy (HR = 0.88, 95% CI: 0.82 to 0.95). Risk of death was increased for older males, those without private insurance, and patients with Stage IB adenocarcinoma. Conclusions: In the largest study examining the association between hospital teaching status and Stage I pancreatic cancer mortality, our data suggests that there is not a significantly lower mortality rate for patients at academic hospitals compared to patients at community-based hospitals. [Table: see text]