Modelling a regional reorganization of cardiovascular surgery provision

International audienceThe Nord - Pas-de-Calais region of France is under-served in terms of access to cardiovascular surgery services, as illustrated by relatively high levels of waiting list mortality. This prompted the decision to create a new surgical unit (notably with facilities for extracorporeal circulatory support) in the region's densely populated, former industrial heartland called the “Mining Basin". Geographical and epidemiological modelling was used prospectively to estimate the likely future level of activity of the existing public sector cardiovascular surgery units. Furthermore, information on the regional population distribution and the likely pattern of service use enabled us to estimate the new unit's potential activity. Our simulations produced nine scenarios which describe variations in the existing public units' activity ranging from –54% to +95%. This type of approach should enable policy makers to improve the organization of healthcare provision

Management of Patients with Pancreatic Ductal Adenocarcinoma in the Real-Life Setting: Lessons from the French National Hospital Database

Pancreatic ductal adenocarcinoma (PDAC) remains a major public health challenge, and faces disparities and delays in the diagnosis and access to care. Our purposes were to describe the medical path of PDAC patients in the real-life setting and evaluate the overall survival at 1 year. We used the national hospital discharge summaries database system to analyze the management of patients with newly diagnosed PDAC over the year 2016 in Auvergne-Rhône-Alpes region (AuRA) (France). A total of 1872 patients met inclusion criteria corresponding to an incidence of 22.6 per 100,000 person-year. Within the follow-up period, 353 (18.9%) were operated with a curative intent, 743 (39.7%) underwent chemo- and/or radiotherapy, and 776 (41.4%) did not receive any of these treatments. Less than half of patients were operated in a high-volume center, defined by more than 20 PDAC resections performed annually, mainly university hospitals. The 1-year survival rate was 47% in the overall population. This study highlights that a significant number of patients with PDAC are still operated in low-volume centers or do not receive any specific oncological treatment. A detailed analysis of the medical pathways is necessary in order to identify the medical and territorial determinants and their impact on the patient’s outcome