Background: Distal Pancreatectomy (DP) is performed for various indications including malignant and non-malignant pancreatic disease. The objective of this study was to evaluate mortality for DP, predictors of mortality, and review national trends.
Methods: The Nationwide Inpatient Sample (NIS) was queried to identify all DPs performed during 1998-2005. Univariate analyses and multivariable logistic regression were performed to evaluate in-hospital mortality (SASv9.1,Cary, N.C.).
Results: By weighted national estimate 22,097 patient discharges occurred for DP during 1998-2005. 57.6% of patients were women; mean age was 57.4 years [SEM=0.28]. 53.8% of DPs were for malignant pancreatic disease (defined as ICD-9 codes for primary and secondary malignancies, including carcinoma in-situ and neoplasms of uncertain behavior). 46.2% of DPs were for non-malignant disease (defined as pancreatic cysts, pseudocysts, benign neoplasms, and pancreatitis), P<.0001. The number of DPs increased over time with 1593 performed in 1998 and 3951 performed in 2005, P<.0001. Overall, in-hospital mortality was 3.7%, which declined from 1998(4.7%) to 2005(3.1%), P<.0001. Mortality was higher for men vs. women (2.0% vs. 1.7%, P=.001), older age vs. younger age (>70 6.5%, 50-69 3.5%, <50 1.6%, P<.0001) and malignant vs. non-malignant (4.46% vs. 2.99%,P<.0001). DP associated with laparoscopy comprised 2.9% of all DPs. Mean length of stay (LOS) for non-laparoscopy associated DP was 10.4d and 6.7d for laparoscopy associated DP. There were no significant differences in the rate of laparoscopy in patients with malignant vs. non-malignant disease or over the time course included in the study. Independently significant factors for mortality included age >70 yrs vs. <50 (OR 3.46; 95% CI 2.07-5.80) and >70 vs. 50-69 (OR 1.66; 95% CI 1.15-2.40), men vs. women (OR 1.58;95% CI 1.15-2.17). The presence of medical co-morbidities including chronic lung disease, renal failure, congestive heart failure, and diabetes were significant predictors of increased mortality.
Conclusion: DP is being performed with higher frequency in the US with a concomitant decrease in mortality. Male sex, increasing age, and the presence of medical comorbidities were significantly associated with increased mortality. DPs performed in conjunction with laparoscopy demonstrated a decreased LOS in comparison to non-laparoscopic DP. Additional studies including patient-level data, overall survival, and with more specific coding for laparoscopic DP are warranted to provide a better understanding of the specific predictors of outcome after DP.