title: Starting a High-Quality Pancreatic Surgery Program at a Community Hospital.
abstract: BACKGROUND
  Most literature suggests that pancreatic resections should be done by high-volume surgeons at high-volume hospitals to optimize patient outcomes. However, patient preference and insurance requirements may restrict hospital location. After careful planning, a high-volume pancreatic surgeon started performing pancreatectomies at a community hospital.
  
  
  METHODS
  Sixty pancreatectomies were performed at an academic medical center and 28 at a 144-bed community, non-teaching hospital. Sixty-day outcomes were recorded.
  
  
  RESULTS
  There were no statistically significant differences between the academic medical center and community hospital with regard to the median age of the patients (66 vs. 61 years), the gender distribution (57 vs. 64 % female), or the median BMI (28 vs. 26 kg/m(2)). There was a significant difference in the American Society of Anesthesiologists class distribution between the academic medical center and community hospital (1; 0 vs. 4 %, 2; 7 vs. 21 %, 3; 88 vs. 75 %, 4; 5 vs. 0 %, p = 0.006). The median length of stay (LOS) for 17 pancreaticoduodenectomy/total pancreatectomy patients at the community hospital was significantly less than for 39 patients at the academic medical center (5 vs. 7 days, p = 0.006). Eleven distal pancreatectomy/splenectomy patients at the community hospital tended to have a shorter median LOS than 21 patients at the academic medical center (4 vs. 5 days, p = 0.25). Accordion ≥ 3 complications (7 vs. 27 %) and readmissions (11 vs. 22 %) tended to be lower at the community hospital than the academic medical center. Greater than 80 % of patients with adenocarcinoma at both hospital settings who were recommended to receive adjuvant therapy started their treatment within 60 days of surgery.
  
  
  CONCLUSIONS
  With appropriate planning and careful patient selection, high-quality pancreatic surgery can be performed at a community hospital by a high-volume pancreatic surgeon.
authors.affiliation: Division of Surgical Oncology, University Hospitals Case Medical Center, 11100 Euclid Avenue, Cleveland, OH, 44106, USA. jeffrey.hardacre@UHhospitals.org.
authors.forename: Jeffrey M
authors.initials: JM
authors.lastname: Hardacre
authors.affiliation: Case Western Reserve University School of Medicine, Cleveland, OH, USA.
authors.forename: Siavash
authors.initials: S
authors.lastname: Raigani
authors.affiliation: Division of Gastroenterology, University Hospitals Ahuja Medical Center, Beachwood, OH, USA.
authors.forename: John
authors.initials: J
authors.lastname: Dumot
mesh_terms: D000046:Academic Medical Centers; D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D005260:Female; D006764:Hospitals, Community; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D015397:Program Evaluation; D012189:Retrospective Studies; D013156:Splenectomy
keywords: Community hospital; Pancreatectomy; Regionalization