Major Oncologic Surgery at a Community Hospital.

Hawaii J Med Public Health

Undergraduate Student, University of Hawai'i, Honolulu, HI (HL).

Published: February 2017

AI Article Synopsis

  • A national trend is pushing patients with complex cancer surgeries to high-volume tertiary care centers, but this poses access issues for patients in Hawai'i.
  • The study shows that complex oncologic surgeries can be effectively and safely performed at community hospitals in Hawai'i, with data collected on 136 patients between 2007 and 2014.
  • Results indicate low mortality (0.7%) and manageable complication rates, suggesting that community hospitals can deliver comparable outcomes to larger cancer centers.

Article Abstract

There is a national trend to refer patients requiring complex oncologic surgery to tertiary high-volume cancer centers. However, this presents major access challenges to Hawai'i patients seeking care. The purpose of this study is to demonstrate that complex oncologic surgery can be safely performed at community hospitals like those in Hawai'i. From July 2007 to December 2014, 136 patients underwent complex oncologic procedures at a community hospital in Hawai'i by a single general surgeon. Cases included esophagogastric, hepatobiliary, pancreatic, rectal, and retroperitoneal resections. A database of patients was created from information extracted from the EPIC database. Complications were evaluated using the Clavien-Dindo grading system. There was 0.7% mortality rate (grade V complication). The major morbidity rate was 12.5%, including 10.3% grade III complications and 2.2% grade IV complications. The median length of stay for all operations was 8 days. The mean estimated blood loss for all operations was 708 cc. There was a 2.9% hospital readmission rate within 30 days of initial discharge, and a 5.1% reoperation rate. Complex oncologic procedures can be safely performed at a low-volume community hospital, with outcomes similar to those from high-volume cancer centers.

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Source
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5304426PMC

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