title: HPB surgery can be safely performed in a community teaching hospital.
abstract: BACKGROUND
  There is ongoing debate about feasibility of performing hepatobiliopancreatic (HPB) cases in low-volume, community hospitals. We decided to analyze outcomes of HPB surgical cases done in our community hospital and compare it with published data from academic centers and/or national data.
  
  
  METHODS
  We reviewed all HPB cases (liver, pancreas, and bile duct cases) performed in an 8-year-period (2001-2009) by HPB-fellowship-trained general surgeon (P.F.S.) at the Danbury Hospital, CT, USA. All electronic files of the patients, who underwent HPB surgery, were reviewed, and all pertinent clinical information was retrieved. Complications and mortality were recorded for length of hospital stay and 30 days after discharge. All complications were graded according to Clavien classification. Pancreatic specific complications--pancreatic fistula/leak and delayed gastric emptying--were graded using International Study Group on Pancreatic Fistula and International Study Group of Pancreatic Surgery definitions.
  
  
  RESULTS
  There were 140 HPB cases. These included 33 pancreatoduodenectomies, 29 distal pancreatectomies, 52 hepatic cases, and 26 cases of other cases involving pancreas and biliary tract. Overall complication rate was 36.4%. Using Clavien classifications, there were 26 grade 1 complications, 21 grade 2 complications, and four grade 3 complications. Two patients underwent reoperation for postoperative complications. Overall mortality was 0.7% (one patient). Pancreas-specific complications included 6% pancreatic leak rate after pancreatoduodenectomy and 24.1% leak rate for distal pancreatectomy.
  
  
  CONCLUSIONS
  HPB surgery could be safely performed in community setting, with morbidity and mortality comparable to high-volume centers.
authors.affiliation: Department of General Surgery, Danbury Hospital, 24 Hospital Ave, Danbury, CT 06810, USA.
authors.forename: Andrei
authors.initials: A
authors.lastname: Cocieru
authors.forename: Pierre F
authors.initials: PF
authors.lastname: Saldinger
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001652:Bile Ducts / Q000601:surgery*; D001662:Biliary Tract Surgical Procedures; D013505:Digestive System Surgical Procedures; D005260:Female; D006764:Hospitals, Community / Q000706:statistics & numerical data; D006784:Hospitals, Teaching / Q000706:statistics & numerical data; D006801:Humans; D008099:Liver / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000601:surgery*; D011183:Postoperative Complications; D055815:Young Adult