Complex hepatobiliary surgery in the community setting: is it safe and feasible?
Ronald S Chamberlain1, Zachary Klaassen, Prakash R Paragi
1Department of Surgery, Saint Barnabas Medical Center, Livingston, NJ, USA. rchamberlain@sbhcs.com
American Journal of Surgery
|August 30, 2011
Summary
Complex hepatobiliary surgery can be safely performed in community hospitals, achieving excellent outcomes comparable to specialized centers. This study demonstrates the feasibility and success of advanced liver and bile duct procedures outside major academic institutions.
Area of Science:
- Hepatobiliary Surgery
- Surgical Outcomes
- Community Hospital Practices
Background:
- Complex hepatobiliary procedures are standard at tertiary centers.
- Outcomes in community hospitals remain under-documented.
- Assessing safety and efficacy in non-academic settings is crucial.
Purpose of the Study:
- To evaluate the feasibility and outcomes of complex hepatobiliary surgery at a community hospital.
- To compare results with those typically seen at academic referral centers.
- To inform the debate on centralization of complex surgical procedures.
Main Methods:
- Prospective analysis of 84 patients undergoing complex hepatobiliary surgery (Dec 2004-Dec 2008).
- Data collected included demographics, procedures, perioperative parameters, pathology, and short/long-term outcomes.
- Focus on complications up to 30 days postoperatively.
Main Results:
- Most common procedures: segmentectomies (49%) and major hepatic resections (38%), including lobectomies and trisegmentectomies.
- Metastatic carcinoma was the primary indication for surgery (50%).
- Overall surgical complication rate was 11%.
Conclusions:
- Complex hepatobiliary surgery can be performed safely and effectively at a community-based teaching hospital.
- Excellent outcomes support the inclusion of such centers in discussions regarding surgical procedure centralization.
- Community hospitals with proven outcomes should be considered for complex cases.