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Background: The authors queried three national patient care databases evaluating what data is available to assess the current status and trends for distal pancreatectomy (DP). Methods: From the National Inpatient Sample (NIS, 2003-9), the National Surgical Quality Improvement Project (NSQIP, 2005-10), and the Surveillance Epidemiology and End Results (SEER, 2003-9) DP were identified using appropriate diagnostic and procedural ICD-9 (NIS) and CPT codes (NSQIP). Utilization of minimally invasive surgery (MIS) was defined by ICD-9 procedure code (NIS) but it could not be differentiated if done for resection or diagnosis which was followed by an open resection. We assessed trends in patient demographics, surgical approach, outcome metrics, hospital demographics and surgical volume, and oncologic outcomes. Results: NIS, NSQIP and SEER identified 4242, 2681 and 1259 distal pancreatectomy resections, respectively. Mean age was 60.8 years (NIS) and 61.9 years (NSQIP). There was a female predominance, (NIS 62%, NSQIP 59%, SEER 55%). Mean BMI was 28.0 and 13% of patients had BMI > 35 (NSQIP). There was no significant change of BMI or frequency of BMI > 35 over the course of study. MIS was utilized in 15% of operations and splenectomy was performed in 72% (NIS). The use of MIS did not change significantly over the course of the study. Resection was performed for malignancy in 59% (NIS) and 66% (NSQIP). The mean length of stay (LOS) was significantly longer in patients with malignancy vs. benign disease (10.1 vs. 8.4 days, p<0.001, NIS; and 8.6 vs. 7.4 days, p<0.001, NSQIP) and LOS was reduced in resections for malignancy where MIS was used (NIS). Mean hospital charges were \,723.27 (NIS) and were not significantly different between MIS and open resection. The majority of resections were performed in teaching hospitals (77% NIS and 85% NSQIP), but MIS was not more likely to be used in teaching hospitals. Mean annual hospital volume for hospitals performing resection was less than one case per year (NIS). Hospitals in the top decile for volume were more likely to be teaching hospitals than lower volume deciles (88% vs 43%), and were no more likely to utilize MIS at resection. Complication rate in teaching and the top decile hospitals was not significantly decreased.Over the time course of the study, there was significant increase in lymph node (LN) harvest at resection for malignant disease but distribution of histologic type (ductal 30%, IMPN 21%, NET 15% and islet cell tumor 7%) was unchanged. One-year survival (mean 76.4%) was also unchanged (SEER). Conclusions: Each database shows unique aspects of the trends in DP, demonstrating their individual advantages and weaknesses. There appears to be an overall underutilization of laparoscopy for distal pancreatectomy across the United States despite the benefits demonstrated on multiple published series.