ARE THERE ANY DIFFERENCES IN OUTCOMES WITH THE VARIOUS SURGICAL APPROACHES TO MANAGEMENT OF CHRONIC PANCREATITIS; AN AMERICAN COLLEGE OF SURGERY (ACS) NATIONAL SURGICAL QUALITY IMPROVEMENT PROGRAM (NSQIP) SURVEY
George N. Baison*, Janelle Rekman, Morgan M. Bonds, Scott Helton
Gastroenterology, Virginia Mason Medical Center, Seattle, WA
Background: Several options exit for surgical management of chronic pancreatitis refractory to medical management such as total pancreatectomy (TP), distal pancreatectomy (DP), pancreaticoduodenectomy (Whipple) and drainage procedures (Frey, Berger, Bern, Puestow). The choice of procedure is often in the hands of the surgeon and the best approach remains debatable. This study seeks to evaluate the scope of surgical practice and outcomes among American College of Surgery (ACS) National Surgical Quality Improvement Program (NSQIP) participating hospitals and any differences between the outcomes of the various operations for chronic pancreatitis.
Methods: We queried the ACS NSQIP database for patients that had an operation for chronic pancreatitis from 2014, the first year with a pancreatectomy-specific participant user file (PUF) to 2017, the most recent NSQIP PUF. Procedure performed, demographics and surgical outcomes were identified. Univariate analysis was performed to compare the different surgical procedures. Logistic regression analysis was then performed to evaluate factors associated with poor outcome.
Results: A total of 24,321 pancreatectomies were performed by 106, 120, 137 and 142 participating hospitals in 2014, 2015, 2016 and 2017, respectively. Of these operations 1315 (5%) were for chronic pancreatitis. The cohort had a mean age of 53 (18 - 88) years, mean BMI of 26.37 (10.54 - 51.32), 44% of patients smoked, 30% were diabetic, 57% were male, and 71% had ASA class 3 or higher. Average operative time was 302 minutes, with a mean length of stay of 10 days. The most common procedure was DP (44%) followed by Whipple (26%) and then drainage procedures making up 24%. TP was performed in 6% of patients. Overall complication rate (major and minor) was 39.62%, while mortality was 1.75%. Significant differences between procedures were noted in operative time, length of stay, overall complication rate and mortality (TP>Drainage>Whipple>DP for all these measures). DPs had higher fistula rates (18% vs 15% for drainage procedures vs 12% for Whipple, p-value < 0.05). Logistic regression showed that overall complications were associated with higher ASA class (OR1.76, CI: 1.41 - 2.19) and increased operative time (OR1.003, CI: 1.002 - 1.004) and but not directly with type of procedure.
Conclusion: Pancreatectomy for chronic pancreatitis remains a morbid operation with a significant complication rate regardless of the type of procedure performed. These findings are consistent with prior literature. However, the type of operation itself is not an independent predictor of poor outcome. Additional investigation is needed to elucidate other factors predictive of poor patient outcomes such as alcohol consumption, smoking, gland and bile duct pathology, and response or lack thereof to medical and endoscopic management.
Back to 2019 Posters
