Complex pancreatic surgery: safety and feasibility in the community setting.
BACKGROUND
Advances in technology, innovative surgical procedures, and enhanced perioperative care have allowed more patients to be considered for complex pancreatic surgery. Published reports on the outcomes of pancreatic surgery performed at high volume tertiary referral centers have yielded excellent results. However, similar outcome and safety data from community hospitals is limited.


METHODS
Consecutive complex pancreatic surgery performed by a single surgeon from December 2004 to December 2009 formed the study group. Factors analyzed included patient demographics, operative procedure, operative time, length of hospital stay, pathology, and 30-day morbidity and mortality.


RESULTS
One hundred and nine consecutive patients underwent pancreatic surgery, with a mean patient age of 62.4±15.2 years. Eighty-three patients (76.1%) underwent definitive surgical procedure and 26 patients (23.9%) had palliative bypass after failed palliative biliary stenting. The mean operative time was 229±109 min, the mean length of stay was 8.6±6.5 days and 24 (22.0%) patients had surgical complications.


CONCLUSIONS
Complex pancreatic surgery can be performed safely at high-volume tertiary community hospitals with excellent outcomes comparable to tertiary academic centers. In the ongoing debate about the need for mandatory referral of complex surgical procedures, tertiary community hospitals with well-determined outcomes should be included.
Department of Surgery, Saint Barnabas Medical Center, 94 Old Short Hills Road, Livingston, NJ 07039, USA. rchamberlain@sbhcs.com
Ronald S
RS
Chamberlain
Matthew
M
Tichauer
Zachary
Z
Klaassen
Prakash R
PR
Paragi
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000592:standards*; D010182:Pancreatic Diseases / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000592:standards*; D010193:Pancreaticojejunostomy / Q000592:standards*; D015203:Reproducibility of Results; D012189:Retrospective Studies