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Outcomes of complex gastrointestinal procedures performed in a community hospital

Matthew H Guzzo1, Jeffrey Landercasper, William C Boyd

  • 1General and Vascular Surgery Department, Gundersen Lutheran Medical Center, La Crosse, WI 54601, USA.

WMJ : Official Publication of the State Medical Society of Wisconsin
|October 13, 2005
PubMed

Insights

Complex gastrointestinal (GI) procedures can achieve excellent outcomes at lower-volume hospitals. This study demonstrates that patient care quality is not solely dependent on procedure volume, challenging traditional regionalization strategies.

Area of Science:

  • Surgical Outcomes Research
  • Gastrointestinal Surgery
  • Healthcare Management

Background:

  • Complex gastrointestinal (GI) procedures are defined by high morbidity, mortality, and technical demands, occurring in <6000 US patients annually.
  • Previous research indicates a direct correlation between surgical procedure volume and patient outcomes.
  • The established volume-outcome relationship is a key consideration in healthcare planning for specialized surgical services.

Purpose of the Study:

  • To evaluate the feasibility of achieving favorable outcomes for complex GI procedures in a lower-volume hospital setting.
  • To assess the impact of a commitment to surgical residency training on patient outcomes for complex GI procedures.
  • To challenge the notion that high-volume centers are exclusively superior for complex GI procedures.

Main Methods:

  • Retrospective chart review of 106 patients undergoing non-emergent complex GI procedures between July 1989 and June 1997.
  • Procedures included esophagectomy, total gastrectomy, major hepatic resection, pancreaticoduodenectomy, biliary tract anastomosis, and total abdominal proctocolectomy.
  • Data collected included patient demographics, comorbidities, indications for surgery, length of stay, morbidity, and mortality.

Main Results:

  • Average length of stay was 13.2 days, with major complications in 14% of patients and a mortality rate of 1.9%.
  • Outcomes (length of stay, morbidity, mortality) were comparable or superior to published data from high-volume centers.
  • The patient cohort included individuals aged 19-90 with significant comorbidities (45.3%) and a high proportion undergoing surgery for malignancies (68.9%).

Conclusions:

  • Complex GI procedures can yield excellent patient outcomes even in lower-volume medical centers.
  • Healthcare regionalization strategies should incorporate outcome data, not solely rely on procedure volume.
  • Commitment to surgical residency training may contribute to high-quality care in complex GI surgery at non-specialized centers.
Abstract

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