Department of General Surgery, Danbury Hospital, 24 Hospital Ave, Danbury, CT 06810, USA.
J Gastrointest Surg. 2010 Nov;14(11):1853-7. doi: 10.1007/s11605-010-1215-x. Epub 2010 May 18.
There is ongoing debate about feasibility of performing hepatobiliopancreatic (HPB) cases in low-volume, community hospitals. We decided to analyze outcomes of HPB surgical cases done in our community hospital and compare it with published data from academic centers and/or national data.
We reviewed all HPB cases (liver, pancreas, and bile duct cases) performed in an 8-year-period (2001-2009) by HPB-fellowship-trained general surgeon (P.F.S.) at the Danbury Hospital, CT, USA. All electronic files of the patients, who underwent HPB surgery, were reviewed, and all pertinent clinical information was retrieved. Complications and mortality were recorded for length of hospital stay and 30 days after discharge. All complications were graded according to Clavien classification. Pancreatic specific complications--pancreatic fistula/leak and delayed gastric emptying--were graded using International Study Group on Pancreatic Fistula and International Study Group of Pancreatic Surgery definitions.
There were 140 HPB cases. These included 33 pancreatoduodenectomies, 29 distal pancreatectomies, 52 hepatic cases, and 26 cases of other cases involving pancreas and biliary tract. Overall complication rate was 36.4%. Using Clavien classifications, there were 26 grade 1 complications, 21 grade 2 complications, and four grade 3 complications. Two patients underwent reoperation for postoperative complications. Overall mortality was 0.7% (one patient). Pancreas-specific complications included 6% pancreatic leak rate after pancreatoduodenectomy and 24.1% leak rate for distal pancreatectomy.
HPB surgery could be safely performed in community setting, with morbidity and mortality comparable to high-volume centers.
在低容量的社区医院进行肝胆胰（HPB）手术的可行性仍存在争议。我们决定分析在我们的社区医院进行的 HPB 手术病例的结果，并将其与学术中心和/或国家数据公布的结果进行比较。
我们回顾了 2001 年至 2009 年间，由一名接受过 HPB 研究员培训的普外科医生（PFS）在康涅狄格州丹伯里医院进行的所有 HPB 病例（肝脏、胰腺和胆管病例）。对所有接受 HPB 手术的患者的电子病历进行了审查，并检索了所有相关的临床信息。记录了并发症和死亡率，以及住院时间和出院后 30 天的情况。所有并发症均根据 Clavien 分类进行分级。胰腺特异性并发症 - 胰瘘/漏和胃排空延迟 - 使用国际胰腺瘘研究组和国际胰腺外科研究组的定义进行分级。
共有 140 例 HPB 病例。其中包括 33 例胰十二指肠切除术、29 例胰体尾切除术、52 例肝切除术和 26 例涉及胰腺和胆道的其他病例。总体并发症发生率为 36.4%。根据 Clavien 分类，有 26 例 1 级并发症、21 例 2 级并发症和 4 例 3 级并发症。有两名患者因术后并发症接受了再次手术。总体死亡率为 0.7%（1 例）。胰腺特异性并发症包括胰十二指肠切除术后胰漏率为 6%，胰体尾切除术后漏率为 24.1%。
HPB 手术可以在社区环境中安全进行，其发病率和死亡率与高容量中心相当。
