[Pancreatic surgery in a regional hospital].
BACKGROUND
Recently it was shown that in several surgical procedures the case load of an institution correlated in direct proportion with the outcome. Therefore, the German authorities with effect from January 1, 2008 have defined the minimum case load per year of an institution for selected surgical procedures in order to increase the medical quality and improve the outcome. Until now, however, there is no experience in establishing a medical centre for pancreatic surgery according to these regulations. The aim of this study was, therefore, to describe the possibilities and the prerequisites necessary to establish a new pancreatic centre according to the requirements of the German official regulations.


METHODS
In a prospective clinical study, the data of 269 patients who underwent a resective surgical procedure for pancreatic diseases between May 1998 and August 2007 were analysed. All included patients underwent a defined surgical procedure for malignant and benign lesions of the pancreatic gland. Indication for operation, operative procedure, postoperative morbidity and mortality were analysed in this study.


RESULTS
After the year 2000, the annual case load of pancreatic resections per year amounted to over 30 patients. In most cases (n = 127) the indication for operation was a malignant disease of the pancreatic head, in 94 cases the patients were operated for chronic pancreatitis with a benign tumour of the pancreatic head. In most cases (n = 106) a pylorus-preserving partial duodenopancreatectomy was performed followed by the duodeno-preserving pancreatic head resection (Beger procedure, n = 55). The overall complication rate amounted to 30.2 %, overall mortality 0.7 %. Two patients died on the 37 (th) and 44 (th) day postoperatively.


CONCLUSIONS
The establishment of a medical centre for pancreatic surgery is possible according to the regulations of the German authorities. Nevertheless, there are multiple factors influencing medical quality apart from the case load of a hospital. These are a well-functioning intensive care unit and the possibility for radiological and/or gastroenterological interventions 24 hours a day. Most important is the personal motivation of the doctors and nurses in successfully supporting such a programme. So far the prospective implication on health care or medical education cannot be finally anticipated. The different independent factors of medical quality concerning pancreatic surgery have still to be identified and should reasonably influence any governmental or institutional regulations.
Calasan
I
I
Chirurgische Abteilung, Rotkreuzklinikum, München, Deutschland.
Junger
M
M
Schwendtner
P
P
Pommer
S
S
Schoenberg
M H
MH
D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D017052:Hospital Mortality; D006769:Hospitals, General / Q000706:statistics & numerical data*; D006779:Hospitals, Public / Q000706:statistics & numerical data*; D006782:Hospitals, Special / Q000458:organization & administration / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000401:mortality / Q000706:statistics & numerical data*; D010182:Pancreatic Diseases / Q000453:epidemiology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000453:epidemiology / Q000601:surgery*; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data*; D014600:Utilization Review / Q000706:statistics & numerical data