Exporting excellence for Whipple resection to refine the Leapfrog Initiative.

Area of Science:

• Surgical Oncology
• Health Services Research

Background:

• The Leapfrog Group promotes regionalizing complex procedures like the Whipple resection at high-volume hospitals (HVH).
• Implementation challenges exist for regionalization, particularly in rural areas and for facilities serving the uninsured.
• Alternatives are needed to extend the reach of high-quality surgical care.

Purpose of the Study:

• To investigate if a low-volume hospital (LVH) can safely perform Whipple resections by defining and exporting key surgical elements.
• To assess the impact of quality improvement initiatives on surgical processes at an LVH.

Main Methods:

• A quality improvement program was implemented at a LVH (San Mateo Medical Center).
• Exportable elements of the Whipple resection were defined through consultation with high-volume surgeons.
• Perioperative preparation was supported by a senior pancreas consultant.

Main Results:

• Four out of nine patients undergoing exploratory surgery for Whipple resection had a successful procedure.
• Minimal morbidity and zero 30-day mortality were observed.
• The LVH demonstrated improved structure and processes of care.

Conclusions:

• Whipple resections can be safely executed at LVHs through the export of surgical expertise and enhanced care protocols.
• Quality improvement measures at LVHs can significantly improve surgical care.
• Feasible alternatives to the Leapfrog Initiative can broaden access to complex surgical procedures.