SAFETY, EFFICACY, AND COST OF PANCREATICODUODENAL RESECTION IN A SPECIALIZED CENTER BASED AT A COMMUNITY-HOSPITAL

Objective: To determine whether pancreaticoduodenal resection (PDR) fo r benign and malignant disease can be performed safely, efficiently, a nd economically at a 50-bed community hospital. Design: Retrospective review of 39 consecutive PDRs performed in an 18-month period. Indicat ions for surgery, length of hospital stay, complications, and patient charges were analyzed. Setting: A suburban 50-bed community hospital. Patients: Thirty-nine patients (15 male and 24 female) referred for PD R for benign and malignant disease. Main Outcome Measures: Mortality a nd morbidity rates, length of hospital stay, care, and cost. Results: Of 39 patients who underwent PDRs, 1 patient (2.6%) died of myocardial infarct. Intraoperative blood transfusions were required by 3 patient s (8%). The mean postoperative hospital stay was 11 days. Twenty-four patients (62%) were discharged by day 11. Fifteen patients (38%) were hospitalized 11 to 24 days. Complications in 10 patients (28%) include d pancreatic or biliary fistula (n=6), upper gastrointestinal tract bl eeding (n=1), partial wound dehiscence (n=1),bacteremia (n=1), and pne umonia (n=1). No patient required reoperation. Three patients were reh ospitalized within 1 month. Mean patient charges were $21 864, and mea n reimbursements were $19 669. Conclusions: Pancreaticoduodenal resect ion can be accomplished with low morbidity and mortality rates and a s hort stay at a community hospital. Thorough preoperative investigation s to exclude unresectable lesions must precede every PDR for malignant disease. Mortality and morbidity rates in this series were similar to those for patients with similar diagnoses who were operated on in aca demic centers. Cost for and length of hospital stay of these 39 patien ts were significantly lower than those in other reported series.