Hepatopancreaticobiliary Surgical Outcomes at a Community Hospital

Abstract

There is a national trend towards regionalizing complex hepatopancreaticobiliary (HPB) surgeries to high-volume institutions. Due to geographic and socioeconomic constraints, however, many patients in the United States continue to undergo HPB surgery at local community hospitals. This study evaluated complex HPB surgeries performed by a single surgeon at a low-volume community hospital from May 2007 to June 2021. A retrospective review of medical records (n=163) was done to collect data on patient demographics and outcomes. Surgical outcomes of HPB procedures were compared to published data from high-volume centers. Overall mortality within 30 days of the procedure was 1% (n=1). Using Clavien-Dindo classification, the major complication rate was 10%, including 8% grade III and 2% grade IV complications. Reoperation (2%) and readmission (3%) were rare in this population. Median length of stay was 7 days and median estimated blood loss was 500 milliliters. Surgical outcomes from the community hospital were comparable to high-volume centers. For pancreatic cancer patients treated at the community hospital, Kaplan-Meier curves revealed comparable 5-year survival time to national data. Complex HPB procedures can be safely performed at a low-volume hospital in Hawai'i with outcomes comparable to large tertiary centers.

Keywords: HPB surgery; liver resection; low-volume center; pancreatic resection; postoperative outcome.

Figure 1.

Long-Term Survival of Straub Medical Center Patients Diagnosed with Pancreatic Cancer (N = 49). The Kaplan-Meier curve represents survival time in years for pancreatic cancer patients who underwent a complex HPB surgery (nWhipple = 42, ndistal pancreatectomy = 7). Numbers above the curve represent the number of patients lost at the given time.

Figure 2.

Effect of Lymph Node Status on the Long-term Survival of Straub Medical Center Patients Diagnosed with Pancreatic Cancer (N = 49). The Kaplan-Meier survival estimate represents survival time in years for pancreatic cancer patients who underwent a complex HPB surgery (nWhipple = 42, ndistal pancreatectomy = 7). “Node negative” defined as lack of cancer in lymph nodes (nnegative = 23). “Node positive” defined as presence of cancer in lymph nodes (npositive = 26). Numbers above the curve represent the number of patients lost at the given time.

Figure 3.

Survival of Pancreatic Cancer Patients at Straub Medical Center. Kaplan-Meier curve shows 5-year survival data from Straub Medical Center. The sample consisted of a total of n=49 pancreatic cancer patients who either underwent surgery between 2007 and 2013 or 2014 and 2021.