Improved Pancreaticoduodenectomy Outcomes after Starting a Specialized Community Hospital Pancreatic Surgery Program
George Younan, Maged Andrews, Umadevi Rangarajan, Danielle Eganhouse, Robert F. Ahmed, Timothy R. Shaver.
Background: Recent trends in centralization of pancreatic surgery happened as a response to improved outcomes in tertiary care institutions. The volume-outcome relationship is true for high volume hospitals and surgeons. Obstacles to patient travelling to high volume institutions and widespread quality care in community hospitals led to establishing a quality specialized pancreatic surgery program in the community.
Methods: Two pancreatic surgery specialists relocated their program from a tertiary care center to a community hospital. Results of the first sixty-two pancreaticoduodenectomy and total pancreatectomy procedures were studied.
Results: One hundred and seventeen pancreatic surgery cases were analyzed, sixty-two pancreaticoduodenectomy and total pancreatectomy cases were included. Patient demographics were not different in regard to the median age (67 vs. 62 years), gender (65 vs. 62% males), median BMI (26.2 vs. 26 kg/m2), or American Society of Anesthesiologists class, in between the two hospitals. There was a significant decrease in the operative time (350 vs. 281 minutes, p=0.0001), estimated blood loss (409 vs. 156 milliliters, p=0.003), and length of hospital stay (7.2 vs. 5.2 days, p=0.0001). Most patients were operated on for a diagnosis of malignancy (74.2%), and the R0 resection rate was better at the community hospital reaching 95.2%. Transfusions, delayed gastric emptying and leaks tended to be better at the community hospital but did not reach statistical significance.
Conclusion: With dedicated institutional support and careful program design, complex procedures such as PD can be successfully relocated to the community where superior results can be achieved.View pdf