Safety, efficacy, and cost of pancreaticoduodenal resection in a specialized center based at a community hospital.

OBJECTIVE: To determine whether pancreaticoduodenal resection (PDR) for benign and malignant disease can be performed safely, efficiently, and economically at a 50-bed community hospital. DESIGN: Retrospective review of 39 consecutive PDRs performed in an 18-month period. Indications for surgery, length of hospital stay, complications, and patient charges were analyzed. SETTING: A suburban 50-bed community hospital. PATIENTS: Thirty-nine patients (15 male and 24 female) referred for PDR for benign and malignant disease. MAIN OUTCOME MEASURES: Mortality and morbidity rates, length of hospital stay, care, and cost. RESULTS: Of 39 patients who underwent PDRs, 1 patient (2.6%) died of myocardial infarct. Intraoperative blood transfusions were required by 3 patients (8%). The mean postoperative hospital stay was 11 days. Twenty-four patients (62%) were discharged by day 11. Fifteen patients (38%) were hospitalized 11 to 24 days. Complications in 10 patients (28%) included pancreatic or biliary fistula (n = 6), upper gastrointestinal tract bleeding (n = 1), partial wound dehiscence (n = 1), bacteremia (n = 1), and pneumonia (n = 1). No patient required reoperation. Three patients were rehospitalized within 1 month. Mean patient charges were $21,864, and mean reimbursements were $19,669. CONCLUSIONS: Pancreaticoduodenal resection can be accomplished with low morbidity and mortality rates and a short stay at a community hospital. Thorough preoperative investigations to exclude unresectable lesions must precede every PDR for malignant disease. Mortality and morbidity rates in this series were similar to those for patients with similar diagnoses who were operated on in academic centers. Cost for and length of hospital stay of these 39 patients were significantly lower than those in other reported series.

Spontaneous coronary dissection treated with directional coronary atherectomy.

We report a case of spontaneous coronary dissection occurring in a middle aged male which was treated with thrombolytic therapy and directional coronary atherectomy. This technique provides a new option for treating this entity in the cardiac catheterization laboratory.