Outcomes of complex gastrointestinal procedures performed in a community hospital.

BACKGROUND Complex gastrointestinal (GI) procedures have been defined as those that are associated with higher morbidity and mortality, require a high level of technical expertise, and occur in less than 6000 patients per year in the United States. Prior studies suggest a direct volume-outcome relationship. HYPOTHESIS Complex GI procedures may be performed with good outcomes in a lower volume hospital with a commitment to surgical residency training. METHODS Retrospective chart review of all patients undergoing non-emergent operations that are considered complex GI procedures (esophagectomy, total gastrectomy, major hepatic resection, pancreaticoduodenectomy, biliary tract anastomosis, and total abdominal proctocolectomy) from July 1989-June 1997 in a rural referral medical center. RESULTS One hundred six consecutive patients underwent complex GI procedures during a 7-year period ending June 1997. Patients ranged from 19-90 years (mean 62). Forty-eight patients (45.3%) had 1 or more major comorbidities. Seventy-three patients (68.9%) had operations for malignancies. Average length of stay (LOS) was 13.2 days (range 5-38). Major complications occurred in 15 patients (14%). Two patients died (mortality 1.9%), 1 after esophagectomy and 1 after a Whipple procedure. LOS, morbidity, and mortality were less than or equivalent to published reports from high-volume medical centers. CONCLUSION Excellent outcomes for complex GI procedures can be achieved at lower volume medical centers. Regionalization strategies to improve patient care should be based on outcome studies rather than volume alone.