Effect of surgeon specialty and health system characteristics on outcomes after pancreatic adenocarcinoma resection.

663 Background: Outcomes for pancreatic adenocarcinoma patients have improved with multidisciplinary care and centralization at high-volume centers. While surgeon and hospital volume have been linked to improved short-term mortality, the extent to which surgeon specialty influences long-term survival and through which mechanisms remain unclear. Methods: We analyzed SEER-Medicare data (2000–2020) for patients with pancreatic adenocarcinoma undergoing resection. Self-reported surgeon specialty (surgical oncologist vs general surgeon) was identified using the Medicare Provider Enrollment, Chain and Ownership System data (2008–2020) and validated with Medicare Plan B data (full sample). The primary outcome was overall survival (time from cancer diagnosis to death). Results: Among 10,201 resections (median age 74 years; 51% female; 79% pancreatoduodenectomy), surgeries by surgical oncologists were more often at teaching hospitals, NCI-designated centers, and high-volume practices. These patients were more likely white, higher-income, earlier tumor stage, more frequently received multimodality therapy, and had lower complication rates, shorter length of stay, lower rate of futile surgery (cancer-related death within 6 months of surgery), and longer median survival (19 vs 17 months, p