LONG TERM HEALTH-RELATED QUALITY OF LIFE OUTCOMES IN PEDIATRIC PATIENTS UNDERGOING TOTAL PANCREATECTOMY WITH ISLET AUTOTRANSPLANTATION
Michael E. Johnston*1,2, Al-Faraaz Kassam1,2, Alexander R. Cortez1,2, Tom K. Lin2,1, Maisam Abu-El-Haija2,1, Jaimie D. Nathan1,2
1Surgery, University of Cincinnati, Cincinnati, OH; 2Cincinnati Children's Hospital Medical Center, Cincinnati, OH
Introduction: Pediatric patients with chronic (CP) or acute recurrent pancreatitis (ARP) have worse health-related quality of life (HRQOL) scores compared to children without. Total pancreatectomy with islet autotransplantation (TPIAT) is considered as a therapeutic option only after failure of medical and endoscopic therapies. Therefore, we hypothesized that patients who underwent TPIAT would have improvement in postoperative HRQOL score regardless of post-operative adverse events or complications.
Methods: A retrospective review of all patients who underwent TPIAT from 2015 to 2019 was performed. Patients completed a Short Form 36-Item Health Survey (SF-36) and pancreas quality of life (QOL) questionnaire at enrollment and postoperatively up to 48 months. The SF-36 is a 36-item questionnaire divided based on Mental and Physical Health with 8 sub-categories. The pancreas QOL questionnaire consists of 4 questions focused on pain and exocrine insufficiency. Demographic information, hospital course, postoperative outcomes, and QOL questionnaire results were extracted from clinical records. Adverse events and Clavien-Dindo post-operative complications were recorded.
Results: 52 patients underwent TPIAT (median age 13, 69.2% female). All 37 patients greater than or equal to 12 years completed the SF-36 at enrollment, as well as the pancreas QOL assessment. Eleven patients (21.1%) had a Clavien-Dindo complication within 30 days, while 4 (7.7%) had a later complication within one year requiring intervention. Four patients underwent re-operation within 30 days and 4 additional patients underwent operation later, within one year (7.7%). Three patients (5.8%) were readmitted within the first month after operation and 27 (51.9%) were readmitted within the first year. Median postoperative follow-up was 18 months (IQR 3, 24).
SF-36 and subdivided Mental and Physical Health scores improved postoperatively compared to preoperatively (Figure 1). Additionally, patients showed improvement in seven of the 8 subcategories of SF-36 (Figure 2). Patients also had improved pancreas QOL scores postoperatively at one year (2.2 vs 3.1 out of 5, p=0.01).
Experiencing a complication or reoperation, early or late, did not have an impact on Mental, Physical, or Total SF-36 scores throughout follow-up. Having a single readmission did not affect SF-36 scores, but experiencing three or more readmissions resulted in a lower Mental and Total SF-36 score at 18 months (49.4 vs. 79.33, p<0.01; 56.00 vs. 82.25, p<0.01; n=2 vs 18, respectively).
Conclusion: TPIAT is an effective operation for debilitating CP or ARP in pediatric patients, despite known risk for surgical complications. Despite these complications, patients experience improvement in HRQOL scores across two assessment tools, demonstrating the effectiveness of TPIAT as a treatment for this debilitating disease in children.
Figure 1: TPIAT SF-36 Mental, Physical, and Total Scores vs. Time: Significance from Wilcoxon Signed Ranks Test compared to Enrollment Score; * p=0.05, ** p≤ 0.01, *** p≤ 0.001; Error bars represent standard deviation
Figure 2: TPIAT SF-36 Sub-Categories Scores vs. Time: Significance from Wilcoxon Signed Ranks Test compared to Enrollment Score; * p=0.05, ** p≤ 0.01, *** p≤ 0.001; Error bars represent standard deviation
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