We describe the surgical experience of the University of California, San Francisco at the San Mateo Medical Center (SMMC) from 2002 to 2004. A quality improvement program was introduced at this LVH, focusing on enhancing structure and processes of care. High-volume UCSF pancreas surgeons were polled to define exportable elements of Whipple resection. A senior pancreas consultant assisted in the perioperative preparation of SMMC.
Of the nine patients who underwent exploratory surgery for an intended Whipple resection, four had a successful resection, and five were unresectable. Morbidity was minimal and 30-d mortality was zero.
Whipple resections can be safely performed at a LVH after exporting surgical excellence. The structure and process changes allowed the LVH to improve its quality of care. Alternatives to the Leapfrog Initiative are feasible and can extend its original intent.