@article {Khithani:2011:0003-1348:545,
title = "Feasibility of Pancreaticoduodenectomy in a Nonuniversity Tertiary Care Center: What Are the Key Elements of Success?",
journal = "The American Surgeon",
parent_itemid = "infobike://sesc/tas",
publishercode ="sesc",
year = "2011",
volume = "77",
number = "5",
publication date ="2011-05-01T00:00:00",
pages = "545-551",
itemtype = "ARTICLE",
issn = "0003-1348",
eissn = "1555-9823",
url = "https://www.ingentaconnect.com/content/sesc/tas/2011/00000077/00000005/art00011",
author = "Khithani, Amit and Christian, Derick and Lowe, Kevin and Saad, A. Joe and Linder, Jeffrey D. and Tarnasky, Paul and Jeyarajah, D. Rohan",
abstract = "It is advocated that a favorable outcome for pancreaticoduodenectomy (PD) is related to a high volume at university centers. This article examines the specific elements that allow an equivalent outcome from PD in a nonuniversity tertiary care center (NUTCC). The study was performed
to: 1) evaluate the outcome of PDs done at a NUTCC; 2) study the components of the process that are required to attain success in a NUTCC; and 3) provide a new look at the volumeoutcome relationships in complex surgeries in a novel nonuniversity setting. Medical records of patients
who underwent PD by a single surgeon between September 2005 and August 2008 at a high-volume NUTCC were analyzed. The records were reviewed with respect to preoperative and postoperative data, 30-day mortality, morbidity, and histopathology data. A total of 122 patients underwent PD. The mean
age was 68.2 years. Jaundice was the most common presenting symptom in 57 per cent (69 patients). Thirty-nine patients (32%) underwent a pylorus-preserving PD. The mean operative time was 237 minutes. The mean estimated blood loss was 480 mL. The mean length hospital stay was 13 days. Thirty-day
mortality was 3.2 per cent (four patients) and overall morbidity was 49 per cent. The key factors in developing a team dedicated to the care of the patient undergoing PD are discussed. A center of excellence can be developed in a NUTCC resulting in outcomes that meet and indeed may exceed
nationally reported benchmarks. The key elements to success include a team approach to the patient undergoing PD.",
}