Newsbrief

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Whipple Surgery for Pancreatic Cancer More 
Successful, Less Costly at Regional Centers
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     A high-risk surgical procedure for pancreatic cancer--the
nation's fifth leading cancer killer--is much more likely to be
successful, and to cost less, when it is performed at a major
regional medical center as opposed to lower-volume hospitals. The
results of the study of 501 cases in Maryland are published in
the current issue of Annals of Surgery.
     "Because of the large volumes of procedures that they
perform, and also because they employ leading specialists and
engage continually in clinical innovation, it is not surprising
that academic medical centers should emerge as the safest and
also the most cost-effective places to undergo many types of
high-risk procedures," said Toby Gordon, vice president for
planning and marketing for the Johns Hopkins Health System and
the study's lead author. John Cameron, chief of surgery and
director of the Department of Surgery at the hospital, was a
co-author.
     The study concludes that patients who underwent the complex
pancreatic surgery known as the Whipple procedure at 38
low-volume Maryland hospitals were six times more likely to die
in the hospital than those who were operated on during the same
period of time at Hopkins.
     The in-hospital death rate in the 501 cases reviewed was 2.2
percent at Hopkins, compared to an average of 13.5 percent in
other hospitals. For hospitals that did only one to five cases in
the study period, the mortality rate averaged 19.1 percent. The 
average cost of the procedure at Hopkins was $26,204, compared to
$31,659 at other hospitals. Hopkins performed 54 percent of the
operations reviewed in the study.
     "Costs were lower for precisely the same reasons that
outcomes were better," the authors said.  "Because of the
standardized approach of the experienced team, there was a lower
utilization of intensive care unit resources, avoidance of
excessive use of radiology examinations, laboratory tests and
hospital supplies, and an overall shorter length of stay [in the
hospital]."
     "Regionalization is important not simply to achieve
heightened cost efficiencies and to allow a specialized group of
physicians to develop expertise with relatively unusual health
problems," said Michael E. Johns, dean of the School of Medicine.
"[It also provides] our clinical investigators with the ability
to evaluate the outcomes of their innovative treatment and to
develop new insights that will lead to better therapies for
diseases and conditions that seem hopeless now."
     In the Whipple procedure, part of the pancreas is removed
along with all of the duodenum (a portion of the small
intestine), the gallbladder, bile duct and, sometimes, 
part of the stomach. In the 1960s, there was a zero five-year
survival rate of patients who underwent the Whipple. Now, thanks
in part to clinical improvements introduced at Hopkins, doctors
at the hospital report a five-year survival rate of 26 percent.