A NATIONAL COMPARISON OF SURGICAL VERSUS PERCUTANEOUS DRAINAGE OF PANCREATIC PSUEDOCYSTS: 1997-2001
Publishing Number: 202
John Morton, Alphonso Brown, Joseph Galanko, Jeff Norton, Ian Grimm, Kevin Behrns, Stanford School of Medicine, Stanford, CA, University of North Carolina, Chapel Hill, NC
Background: Competing therapies for pancreatic psuedocyst management are utilized without randomized clinical trial evidence. Single institution case series results have indicated that a surgical approach is superior to percutaneous drainage of pancreatic psuedocysts. To determine if this surgical advantage is persistent, national outcomes for both approaches were compared from 1997-2001. Methods: The National Inpatient Sample, a 20% sample of all non-federal hospital discharges, was queried for both drainage modalities of pancreatic psuedocysts, using ICD9 procedure codes 52.01 for the percutaneous approach and 52.4 and 52.96 for the surgical approach. Further case identification was achieved by also having the accompanying diagnosis of pancreatic psuedocyst, ICD9 diagnosis code 577.2. Both demographic and outcome variables were compared by either T test or Chi-Square analysis with a P value of < .05 as significant. Confounding variables were controlled for with linear and logistic regression models for LOS and mortality respectively. Results: As seen below, no significant demographic differences existed between the two groups. Significant differences in rates of ERCP use, intra-abdominal abscess, LOS, and in-patient mortality did exist favoring the surgical approach. In addition, regression analysis indicated that the differences for mortality and LOS continued after correcting for confounding variables. ERCP use had a protective effect on mortality (Odds Ratio, 0.7) while percutaneous drainage had an increased risk of mortality (Odds Ratio, 1.6). Conclusions: This population-based study indicates that surgical drainage of pancreatic psuedocysts, particularly when coupled with ERCP use, leads to decreased complications, LOS, and mortality in comparison with percutaneous drainage. Further sub-group analysis may reveal a role for percutaneous drainage of pancreatic psuedocysts.
|
Percutaneous (n=8,392) |
Surgery (n=6,522) |
Significance |
Age (Years) |
51.1 |
50.2 |
NS |
Female (%) |
42.6 |
41.0 |
NS |
Charlson Index Score 1-3 (%) |
22.7 |
21.5 |
NS |
Diabetes (%) |
17.4 |
16.7 |
NS |
ERCP (%) |
13.1 |
14.4 |
SIG, P<.02 |
Intra-Abd Abscess (%) |
6.80 |
4.54 |
SIG, P<.0001 |
Blood Transfusion (%) |
9.64 |
8.96 |
NS |
LOS, Days |
21.0 |
14.9 |
SIG, P<.0001 |
Mortality (%) |
5.71 |
2.71 |
SIG, P<.0001 |