title: The 13-year experience of performing pancreaticoduodenectomy in a mid-volume municipal hospital.
abstract: OBJECTIVE
  Pancreaticoduodenectomy (PD) is a complex surgery associated with high morbidity, mortality, and cost. Municipal hospitals have their important role in the public health and welfare system. The purpose of this study was to identify the feasibility as well as the cost-effectiveness of performing PD in a mid-volume municipal hospital based on 13 years of experience with PD.
  
  
  METHODS
  From March 2003 to November 2015, 183 patients underwent PD at Seoul Metropolitan Government - Seoul National University Boramae Medical Center.. Retrospectively collected data were analyzed, with a particular focus on complications. Hospital costs were analyzed and compared with a national database, with patients divided into 2 groups on the basis of medical insurance status.
  
  
  RESULTS
  The percentage of medical aid was significantly higher than the average in Korean hospitals. (19.1% vs. 5.8%, P = 0.002). Complications occurred in 88 patients (44.3%). Postoperative pancreatic fistula (POPF) occurred in 113 cases (61.7%), but the clinically relevant POPF was 24.6% (grade B: 23.5% and grade C: 1.1%). The median hospital stay after surgery was 20 days (range, 6-137 days). In-hospital mortality was 3.8% (n = 7), with pulmonary complications being the leading cause. During the study period, improvements were observed in POPF rate, operation time, and hospital stay. The mean total hospital cost was 13,819 United States dollar (USD) per patient, and the mean reimbursement from the National Health Insurance Service (NHIS) to health care providers was 10,341 USD (74.8%). The patient copayment portion of the NHIS payment was 5%.
  
  
  CONCLUSIONS
  Performing PD in a mid-volume municipal hospital is feasible, with comparable results and cost-effectiveness.
authors.affiliation: Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hongbeom
authors.initials: H
authors.lastname: Kim
authors.affiliation: Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Jung Kee
authors.initials: JK
authors.lastname: Chung
authors.affiliation: Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Young Joon
authors.initials: YJ
authors.lastname: Ahn
authors.affiliation: Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: Hae Won
authors.initials: HW
authors.lastname: Lee
authors.affiliation: Department of Surgery, Seoul Metropolitan Government - Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea.
authors.forename: In Mok
authors.initials: IM
authors.lastname: Jung
keywords: Hospital costs; Mortality; Municipal hospitals; Pancreaticoduodenectomy; Postoperative complications