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Does Length of Preoperative Admission Impact in-Hospital Morbidity and Mortality After Pancreatectomy? a Population-Based Study
Shuja Ahmed^*, Chukwuemeka Obiora, Perry Shen, Clancy J. Clark
General Surgery, Wake Forest Baptist Health, Winston Salem, NC

Introduction: Many patients with newly diagnosed pancreatic adenocarcinoma present with poor performance status. It is unclear if preoperative admission to improve performance status is truly beneficial. The aim of the current study is to determine if preoperative admission increases the in-hospital morbidity and mortality of pancreatectomy. Methods: This is a retrospective cohort study using the Nationwide Inpatient Sample from 1998-2010. We identified patients with a discharge diagnosis of pancreatic malignancy who underwent pancreatectomy. Patients with a secondary diagnosis of neuroendocrine tumor of the pancreas and acute or chronic pancreatitis were excluded. In-hospital morbidity and mortality were compared between patients admitted on the day of surgery with patients admitted before the day of surgery. Results: 6863 patients (median age 67, male 50.1%) were identified during the study period. 22.4% (n=1537) of patients had three or more comorbidities. The majority of the procedures were performed in urban (96.4%), academic centers (80.7%). Median length of stay was 10 days (IQR 8-15). 16.4% (n=1126) of patients were admitted prior to the day of surgery. Overall morbidity and mortality were 56.1% (n=3851) and 4.0% (n=277), respectively. Patients admitted on the day of surgery had lower morbidity than patients admitted prior to the day of surgery, 55.1% vs. 61.5%, respectively (p<0.001). After adjusting for age and comorbidities, admission before the day of surgery was independently associated with significantly higher morbidity (OR 1.2; 95% CI 1.1-1.4). Similarly, patients admitted on the day of surgery had lower mortality than patients admitted prior to the day of surgery, 3.6% vs. 5.9%, respectively (p<0.001). After adjusting for age and comorbidities, admission before day of surgery was independently associated with significantly higher mortality (OR 1.5; 95% CI 1.1-2.0). In addition, mortality increased with each additional preoperative day in the hospital (OR 1.1; 95% CI 1.1-1.2) (Figure 1). Conclusions: Preoperative admission significantly increases the morbidity and mortality associated with pancreatectomy in patients with pancreatic malignancy.

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