title: Complex hepatobiliary surgery in the community setting: is it safe and feasible?
abstract: BACKGROUND
  Complex hepatobiliary surgical procedures for benign and malignant conditions are regularly performed at tertiary academic referral centers with excellent outcomes, but whether similar surgical outcomes are achievable in community hospitals is not well documented.
  
  
  METHODS
  Eighty-four patients underwent complex hepatobiliary surgery between December 2004 and December 2008. Data were prospectively analyzed, including patient demographics, operative procedures, perioperative parameters, pathology, complications up to 30 days postoperatively, and long-term outcomes.
  
  
  RESULTS
  The most frequent procedures performed were isolated segmentectomy or segmentectomies (n = 41 [49%]). Major hepatic resections (n = 32 [38%]) included 25 lobectomies (30%) and 7 trisegmentectomies (8%). Nine patients (11%) had surgical complications, and the most common indications for surgery was metastatic carcinoma (n = 42 [50%]).
  
  
  CONCLUSIONS
  Complex hepatobiliary surgery can be performed safely at a community-based teaching hospital with excellent outcomes. In the ongoing debate centering on mandatory referral and centralization of complex surgical procedures, tertiary community hospitals with well-determined outcomes should be included.
authors.affiliation: Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA. rchamberlain@sbhcs.com
authors.forename: Ronald S
authors.initials: RS
authors.lastname: Chamberlain
authors.forename: Zachary
authors.initials: Z
authors.lastname: Klaassen
authors.forename: Prakash R
authors.initials: PR
authors.lastname: Paragi
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001662:Biliary Tract Surgical Procedures / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D015897:Comorbidity; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000592:standards / Q000706:statistics & numerical data; D006764:Hospitals, Community / Q000706:statistics & numerical data*; D006784:Hospitals, Teaching / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000601:surgery; D009515:New Jersey; D011446:Prospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome