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Background: Length of hospital stay is frequently reported to be reduced with laparoscopic approaches. Few studies have accounted for readmission hospital days which may obviate any perceived benefit. The aim of this study was to evaluate the impact of total laparoscopic approach and other clinicopathologic factors on length of index hospital stay, readmission rates and total hospital days after pancreaticoduodenectomy.
Methods: A retrospective review of clinical, pathologic and outcomes data was performed for all patients undergoing pancreaticoduodenectomy from January 2007 through December 2010 at a single institution. Initial hospital stay, readmission rates, and total hospital stay (initial hospital days plus readmission days) were compared between total laparoscopic pancreaticoduodenectomy (TLPD) and open pancreaticoduodenectomy (OPD). The relationship between the clinicopathological factors and total hospital stay was investigated using univariate and multivariate analyses.
Results: A total of 527 patients were identified having undergone TLPD (n=125) or OPD (n=402). There were no differences in mean age, BMI or ASA Score. A malignant diagnosis was more common in patients undergoing OPD (80% vs. 68%, p=0.004), however, there were no differences in overall or pancreas specific postoperative complication rates. Median length of hospital stay was less for the laparoscopic group (7 vs. 10 days, p<0.001). Hospital readmission within 30 days was observed in 16% and was not different between the TLPD and OPD groups (14% vs. 17%, p=0.4) Common diagnoses on readmission included pancreatic fistula (25%), delayed gastric emptying (21%), and abdominal collection or abscess (20%). Of patients requiring readmission, 62% had Clavien grade 3 or 4 complications diagnosed during initial hospitalization or at subsequent readmission. Median length of readmission hospital stay was 5 days for both TLPD and OPD groups. When accounting for readmission days, total hospital days were less for patients undergoing TLPD compared to OPD (8 vs.11, p<0.001). Multivariate analysis demonstrated that Clavien Grade ≥3) complication (HR 6.9, 95% CI 4.3 - 11.5, P < 0.001) and open approach (HR 2.5, 95% CI 1.5 - 4.4, P < 0.001) were independent predictors of prolonged total hospital stay.
Conclusions: Compared with open approaches, TLDP results in shorter hospital stay, similar readmission rates and less total hospital days. Major complication and open approach are independent predictors of prolonged total hospital stay. Limitations of this study include potential selection bias as noted by a higher incidence of malignancy in the open group. The impact of reduced hospital stay on cost and patient-specific advantages such as improvement in quality of life needs to be evaluated.