Newsbrief ----------------------------------------------------------------- Whipple Surgery for Pancreatic Cancer More Successful, Less Costly at Regional Centers ----------------------------------------------------------------- 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.