PERIOPERATIVE OUTCOMES AND PREDICTORS OF PANCREATIC FISTULA FORMATION IN PANCREATECTOMY FOR CHRONIC PANCREATITIS PATIENTS: AN ANALYSIS OF ACS-NSQIP PROCEDURE-TARGETED PANCREATECTOMY DATABASE FROM 2014-2017
Sushil Kumar Garg*, Harika Kandlakunta
Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN
Introduction: Chronic-pancreatitis is a debilitating disease and can lead to significant morbidity. Patients who are refractory to endoscopic and surgical drainage procedures frequently find themselves on escalating doses of narcotics due to intractable pain. Pancreatic resection is sometimes used as a last resort. We did this study to investigate the peri-operative outcomes of pancreatic resection in CP patients to guide the management.
Methodology: This retrospective cohort study analyzed patients undergoing pancreatectomy for chronic pancreatitis between 2014 and 2017 using the procedure-targeted pancreatectomy database of the American College of Surgeons National Surgery Quality Improvement Program (NSQIP). We excluded patients who had a malignant diagnosis or had received chemotherapy or radiation. We compared the patient characteristics of those who developed a postoperative pancreatic fistula to those who did not. Univariate analyses and multivariate logistic regression models were used to assess predictors of pancreatic fistula and mortality.
Results: A total of 1,358 patients underwent pancreatic resection that also had chronic pancreatitis between 2014-2017. Of these, 56.8% were males. Further analysis shows that 42% of patients had distal subtotal pancreatectomy, 47.5% proximal subtotal pancreatectomy, 5.9% total pancreatectomy and 4.2% other pancreatic procedures. We found 14.3% of these patients developed a pancreatic fistula, 1.8% 30-day mortality and 18.7% had 30 day readmission.Multivariate analysis showed that age between 65-84 years (OR=1.24), soft pancreatic gland texture (OR=2.3) are the predictors of pancreatic fistula formation. Total Pancreatectomy (OR: 0.29) and large duct size >6 mm (OR: 0.54) were protective of pancreatic fistula formation. Total pancreatectomy was the only independent predictor of mortality (OR: 6.3).
Conclusion: Pancreatic resection in chronic pancreatitis patients is associated with significant morbidity and mortality. Large registry analyses of pancreatectomy with procedure-specific data can help for patient selection for pancreatic resection in CP patients.
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