A typographical error in a letter to the editor published...


April 07, 1995

A typographical error in a letter to the editor published Friday misstated the number of consecutive Whipple procedures performed at the Johns Hopkins Hospital without a mortality and cited in a study published in 1993. The correct number is 145.

The Sun regrets the errors.

Whipple Procedure

We would like to respond to the letter from Dr. Craig J. Schaefer (March 28) concerning a study carried out at the Johns Hopkins Hospital evaluating the cost and outcome of the Whipple procedure (a complex operation on the pancreas).

The study compared results from the Johns Hopkins Hospital versus 38 other hospitals throughout the state.

During the 5 1/2 -year study period, there were 12 Whipple procedures performed at Peninsula Regional Hospital, Dr. Schaefer's hospital, with two deaths, for a hospital mortality of 16.7%. In Dr. Schaefer's letter, he states that currently they have done 13 consecutive Whipples without mortality.


We are fully aware that a consecutive number of patients can undergo this complex operation without mortality, having published a study on 15 consecutive Whipple operations without a mortality.

Statistical analysis on a small number of patients, such as the 13 that Dr. Schaefer mentions in his letter, is misleading, and that is why we combined the 230 Whipple operations done in 38 community hospitals throughout the state, to compare to the 271 done at Hopkins.

Perhaps a more important issue raised by Dr. Schaefer, however, is whether or not the institution is responsible for superior results for a high-risk operative procedure, or is the individual surgeon responsible?

Most studies have found that large academic medical centers or regional providers with high volumes of complicated surgical patients have better outcomes. There is evidence that hospital volume is more important than individual surgeon volume.

In other words, as we pointed out in our article, it is the team effort, the experience and expertise acquired by caring for a large number of patients and the commitment of institutional resources that result in the superior outcome, not an individual skilled surgeon.

We therefore continue to support the concept that certain complicated high-risk operations should be regionalized.

Although small community hospitals might at times be successful in managing such patients, experience would suggest that in the long run such patients do better in a tertiary referral center.

Toby A. Gordon, ScD.

John L. Cameron, M.D.


No Sympathy

So baseball is back. Big deal.

I can't believe there will be so many people gullible enough to go back and pay huge sums of money to watch this game.

Don't they realize that it's the fans who encourage the childish and greedy behavior of the players and the owners?

I thought I would be excited when the strike was over, but I am not. I will spend a minimal amount of money this year on major league baseball, only because I have a 6-year-old son who loves the game and doesn't understand the business part that is ruining his favorite sport.

As far as Cal Ripken's streak goes, it has already been tarnished, because Lou Gehrig never had eight months of rest between seasons.

It's a shame that I feel this way, and I know I'm not alone. I have no sympathy for team owners, who started this whole problem years ago by paying the million dollar free agent salaries which they have let skyrocket.

No sympathy for owners who make millions each year and want more. And especially no sympathy for ballplayers, many of whom make more in two games than I make in one year.

So, stay home and watch the games on television. But if you happen to get some free tickets, be sure to take your own food or have your beverages at a neighborhood establishment before you enter the yard. Better yet, go to Frederick or Bowie.

Bill Fritz

Bel Air

A Bold Idea

Peter Jay's March 30 column, recommending that Baltimore City residents be exempt from state income taxes, is a bold and important idea.

Despite the city's enormous assets, the continuing decline in the city's population, decreasing property values and the consequent reduction in the tax base point to a slow death for Baltimore.

To reverse this trend will require a bold rethinking of current policies.

Rather than tinkering around the edges, it is time to take a look at creating broad incentives to bring people and businesses back to the city.

To Mr. Jay's idea I would add another: Make Baltimore a "free trade zone" and exempt from state corporate income taxation goods and services produced in the city.

This will help existing companies to expand and would create a rush of companies wanting to set up business operations in Baltimore.

The economic and social ripple effect would be tremendous, far outweighing any temporary loss in revenue to the state.

Oz Bengur


Safety Net

Contrary to the willful disinformation being spread from the governor's office, the Disability Loan Assistance Program does not in any way duplicate Social Security.

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