title: Feasibility of pancreaticoduodenectomy in a nonuniversity tertiary care center: what are the key elements of success?
abstract: It is advocated that a favorable outcome for pancreaticoduodenectomy (PD) is related to a high volume at university centers. This article examines the specific elements that allow an equivalent outcome from PD in a nonuniversity tertiary care center (NUTCC). The study was performed to: (1) evaluate the outcome of PDs done at a NUTCC; (2) study the components of the process that are required to attain success in a NUTCC; and (3) provide a new look at the volume-outcome relationships in complex surgeries in a novel nonuniversity setting. Medical records of patients who underwent PD by a single surgeon between September 2005 and August 2008 at a high-volume NUTCC were analyzed. The records were reviewed with respect to preoperative and postoperative data, 30-day mortality, morbidity, and histopathology data. A total of 122 patients underwent PD. The mean age was 68.2 years. Jaundice was the most common presenting symptom in 57 per cent (69 patients). Thirty-nine patients (32%) underwent a pylorus-preserving PD. The mean operative time was 237 minutes. The mean estimated blood loss was 480 mL. The mean length hospital stay was 13 days. Thirty-day mortality was 3.2 per cent (four patients) and overall morbidity was 49 per cent. The key factors in developing a team dedicated to the care of the patient undergoing PD are discussed. A center of excellence can be developed in a NUTCC resulting in outcomes that meet and indeed may exceed nationally reported benchmarks. The key elements to success include a team approach to the patient undergoing PD.
authors.affiliation: Cancer Center, Methodist Dallas Medical Center, Dallas, Texas 75208, USA.
authors.forename: Amit
authors.initials: A
authors.lastname: Khithani
authors.forename: Derick
authors.initials: D
authors.lastname: Christian
authors.forename: Kevin
authors.initials: K
authors.lastname: Lowe
authors.forename: A Joe
authors.initials: AJ
authors.lastname: Saad
authors.forename: Jeffrey D
authors.initials: JD
authors.lastname: Linder
authors.forename: Paul
authors.initials: P
authors.lastname: Tarnasky
authors.forename: D Rohan
authors.initials: DR
authors.lastname: Jeyarajah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019985:Benchmarking; D002983:Clinical Competence; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D017052:Hospital Mortality / Q000639:trends*; D006761:Hospitals / Q000706:statistics & numerical data; D006779:Hospitals, Public / Q000706:statistics & numerical data; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000379:methods / Q000401:mortality* / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012189:Retrospective Studies; D018570:Risk Assessment; D017751:Safety Management; D016019:Survival Analysis; D016896:Treatment Outcome; D016526:Workload