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Readmission and Prolonged Hospital Stay After Distal Pancreatectomy: Advantage Laparoscopic Approach
Michael J. Ferrara*, Kristopher P. Croome, Michael B. Farnell, Florencia G. Que, Kaye M. Reid Lombardo, Mark J. Truty, David M. Nagorney, Michael L. Kendrick
Mayo Clinic, Rochester, MN
Background: Several studies have demonstrated shorter hospital stay after laparoscopic distal pancreatectomy (LDP) compared to open approaches (ODP), yet few have considered readmission and its effect on total hospital days. The aim of this study was to evaluate the hospital days required after distal pancreatectomy and assess the value of laparoscopic approaches.
Methods: A retrospective review of patients undergoing distal pancreatectomy at a single institution from 2004 through 2012. Patients with adjacent organ resection were excluded. Clinicopathologic and outcomes data were recorded and index length of stay, 30-day readmission and total hospital days (index admission days + readmission days) were calculated. Prolonged hospital stay was defined as >10 days.
Results: 580 patients underwent distal pancreatectomy with either a laparoscopic (n=238) or open (n=342) approach. Patients were similar with respect to age (59 vs. 57 years), BMI (29 vs 29) and gender (54% vs 51% female), however the ODP group was more likely to have malignant diagnoses (28% vs 38%, p=0.008). Readmission rates were not different between LDP and ODP (17% vs. 16%, p=0.73). Median initial hospital stay (5 vs. 7 days, p<0.001), occurrence of prolonged hospital stay (19% vs. 28%, 0.008) and median total hospital days (5 vs. 7 days, p<0.001) were less for LDP.
Conclusions: Laparoscopic approaches for distal pancreatectomy result in shorter hospital stay, decreased occurrence of prolonged hospital stay, and less total hospital days without differences in readmission rates. Whereas selection bias may affect these results, these findings further support possible advantages of laparoscopic approaches
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