title: Safety, efficacy, and cost of pancreaticoduodenal resection in a specialized center based at a community hospital.
abstract: OBJECTIVE
  To determine whether pancreaticoduodenal resection (PDR) for benign and malignant disease can be performed safely, efficiently, and economically at a 50-bed community hospital.
  
  
  METHODS
  Retrospective review of 39 consecutive PDRs performed in an 18-month period. Indications for surgery, length of hospital stay, complications, and patient charges were analyzed.
  
  
  METHODS
  A suburban 50-bed community hospital.
  
  
  METHODS
  Thirty-nine patients (15 male and 24 female) referred for PDR for benign and malignant disease.
  
  
  METHODS
  Mortality and morbidity rates, length of hospital stay, care, and cost.
  
  
  RESULTS
  Of 39 patients who underwent PDRs, 1 patient (2.6%) died of myocardial infarct. Intraoperative blood transfusions were required by 3 patients (8%). The mean postoperative hospital stay was 11 days. Twenty-four patients (62%) were discharged by day 11. Fifteen patients (38%) were hospitalized 11 to 24 days. Complications in 10 patients (28%) included pancreatic or biliary fistula (n = 6), upper gastrointestinal tract bleeding (n = 1), partial wound dehiscence (n = 1), bacteremia (n = 1), and pneumonia (n = 1). No patient required reoperation. Three patients were rehospitalized within 1 month. Mean patient charges were $21,864, and mean reimbursements were $19,669.
  
  
  CONCLUSIONS
  Pancreaticoduodenal resection can be accomplished with low morbidity and mortality rates and a short stay at a community hospital. Thorough preoperative investigations to exclude unresectable lesions must precede every PDR for malignant disease. Mortality and morbidity rates in this series were similar to those for patients with similar diagnoses who were operated on in academic centers. Cost for and length of hospital stay of these 39 patients were significantly lower than those in other reported series.
authors.affiliation: Institute for Laparoscopic Surgery, Community Hospital, Dobbs Ferry, NY, USA.
authors.forename: A M
authors.initials: AM
authors.lastname: Cooperman
authors.forename: E T
authors.initials: ET
authors.lastname: Schwartz
authors.forename: A
authors.initials: A
authors.lastname: Fader
authors.forename: F
authors.initials: F
authors.lastname: Golier
authors.forename: M
authors.initials: M
authors.lastname: Feld
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006743:Hospital Bed Capacity, under 100; D017721:Hospital Costs; D017052:Hospital Mortality; D006764:Hospitals, Community / Q000191:economics / Q000592:standards*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009518:New York; D016577:Pancreaticoduodenectomy / Q000009:adverse effects* / Q000191:economics* / Q000401:mortality; D010359:Patient Readmission; D011183:Postoperative Complications; D016896:Treatment Outcome