Outcome Analysis of Pancreaticoduodenectomy at a Community Hospital

Afsari, Alan; Zhandoug, Zhou; Young, Shun; Ferguson, Lorenzo; Silapaswan, Sumet; Mittal, Vijay
March 2002
American Surgeon;Mar2002, Vol. 68 Issue 3, p281
Academic Journal
There is an ongoing debate about the proposed regionalization of pancreaticoduodenectomies. The purpose of our study is to demonstrate that good outcomes can be achieved in a well-managed low-volume community hospital. We retrospectively analyzed pathologic findings, morbidity, mortality, and one-year survival in 32 patients who underwent pancreaticoduodenectomy at Providence Hospital over a 10-year period and compared these results with data collected at Johns Hopkins, and the Mayo Clinic. The patients had a mean age of 68.5 ± 2.96 years; 56.3 per cent were female and 71.9 per cent were white. Overall in our series 90.6 per cent of specimens were found to be malignant, which is statistically higher than the 68 per cent at Johns Hopkins (P = 0.013) and not significantly different from Mayo Clinic (76%). The 30-day mortality rate at Providence Hospital was 3.1 per cent, which is not statistically different from Johns Hopkins (1.3%) and Mayo Clinic (3.6%). One-year survival rate at Providence Hospital was 59.4 per cent, which is significantly different from 79 per cent at Johns Hopkins (P = 0.016). The one-year survival rate at Providence Hospital is higher than an approximately 50 per cent average reported nationally. The postoperative complication rate was 62.5 per cent; the most common complication was delayed early gastric emptying (28.1%). A statistical difference in morbidity exists between Providence Hospital and Johns Hopkins (P = 0.027) but not between Providence Hospital and Mayo Clinic (46%). The higher rate of malignant disease treated in the population at Providence Hospital may contribute to a higher complication rate and lower one-year survival rate than the reported rates at Johns Hopkins because of the poorer health of cancer patients. However, statistical analysis of mortality rates for pancreaticoduodenectomy at Providence Hospital show no difference from mortality rates at Johns Hopkins and Mayo Clinic. Therefore in low-volume...


Related Articles

  • Critical condition. Hornestay, David // Government Executive;Mar1998, Vol. 30 Issue 3, p31 

    Presents a panel of experts' reactions to how a federal hospital's two top executives scramble to devise a seamless management plan after the ailing director steps down indefinitely. Issues that arise in succession planning and executive development; Missions and goals of the hospital; Possible...

  • Bureaucratic bullying alive and well.  // Australian Nursing Journal;Sep2005, Vol. 13 Issue 3, p6 

    Focuses on the issue of bureaucratic bullying in public hospitals in Queensland. Allegation against the deputy director of Prince Charles Hospital; Implications of bullying on hospital administration.

  • Managerial competencies of hospital managers in South Africa: a survey of managers in the public and private sectors. Pillay, Rubin // Human Resources for Health;2008, Vol. 6, Special section p1 

    Background: South Africa has large public and private sectors and there is a common perception that public sector hospitals are inefficient and ineffective while the privately owned and managed hospitals provide superior care and are more sustainable. The underlying assumption is that there is a...

  • On the use of administrative databases to support planning activities. Fantini, M.P.; Cisbani, L.; Manzoli, L.; Vertrees, J.; Lorenzoni, L. // European Journal of Public Health;Jun2003, Vol. 13 Issue 2, p138 

    Presents a study that evaluated versions of the Diagnosis Related Group (DRG) classification systems, the Medicare DRG and the All Patient Refined DRG, which are used for planning activities. Differences between the two systems in terms of classification logic and variables used in the...

  • Perception of Departmental Heads and Chief Executives towards Hospital HR Management Issues: A Comparison of Public and Private Hospitals in India. Singh, Gaurav; Singh, Ajay; Singh, Shashi // International Journal of Human Resource Studies (IJHRS);2012, Vol. 2 Issue 3, p46 

    This paper analyses the perception of public and private hospital departmental heads and chief executives towards hospital management issues and compare their perceptions. A survey was conducted on private and public staff members. A total of 200 members formed the sample of which 100 belonged...

  • A Death In Dimmitt. JENNINGS, P. C. // Texas Observer: A Journal of Free Voices;Dec2014, Vol. 106 Issue 12, p13 

    A reprint of the article "A Death In Dimmitt" by P.C. Jennings, which appeared in the February 16, 1979 issue, is presented.

  • Modeling population access to New Zealand public hospitals. Brabyn, Lars; Skelly, Chris // International Journal of Health Geographics;2002, Vol. 1, p3 

    This paper demonstrates a method for estimating the geographical accessibility of public hospitals. Cost path analysis was used to determine the minimum travel time and distance to the closest hospital via a road network. This analysis was applied to 38,000 census enumeration district centroids...

  • Evaluating Emergency Department Resource Capacity Using Simulation. Ahmad, Norazura; Ghani, Noraida Abdul; Kamil, Anton Abdulbasah; Tahar, Razman Mat; Teo, Aik Howe // Modern Applied Science;Nov2012, Vol. 6 Issue 11, p9 

    Emergency departments open 24 hours every day and may receive patients at any time most unexpectedly. Adequate resource planning to meet the various demands in emergency departments is arguably amongst the most critical challenges faced by hospital administrators due to the complexity of the...

  • PROSPECTIVE PAYMENT SYSTEMS AND EVOLUTION OF MANAGEMENT CONTROL IN FRENCH HOSPITALS: AN OVERVIEW. LARTIGAU, Jérôme // Scientific Bulletin - Economic Sciences / Buletin Stiintific - S;Jul2013, Vol. 12 Issue 2, p24 

    This analysis aims at contributing to the debate by exploring recent changes in French public hospitals. It will try to show how a new financing system can entail deep changes inside the management architecture. The structuring of the management control function is still in gestation. In most...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics