Abstracts
1999 Digestive Disease Week

# 2161 MEDICAL RESOURCE UTILIZATION BEFORE AND AFTER PANCREATIC HEAD RESECTION IN CHRONIC PANCREATITIS
Thomas J Howard, Indiana Univ Med Ctr, Indianapolis, IN; J W Jones, T M Dale, D J Selzer, G J Rhoades, Indiana Univ Sch of Medicine, Indianapolis, IN

Pancreatic head resection, either pancreaticoduodenectomy (PD) or duodenal preserving pancreatic head resection (DPPHR), improve quality of life, but their effect on medical resource utilization in patients with chronic pancreatitis are unknown. We compared hospitalization rates, medical care costs, and pain scores both pre and postoperatively in 34 patients with chronic pancreatitis treated by either PD or DPPHR. METHODS: From 1992 to 1997, 34 patients with chronic pancreatitis treated by either PD (n = 13) or DPPHR (n = 21) were analyzed. Follow-up occurred for a mean of 26 months preoperatively (range 9 - 36) and 41 months postoperatively (range 12 - 73 mos.). Hospitalization rates and medical care costs were collected from TSI integration of patient financial (IBAX system) and clinical data (PHAMIS system). Quality of life questionnaires with a visual analogue pain scale (VAS) were used to measure outcome. Continuous data were analyzed using the t-test, nominal data using Fischer's exact test, and cumulative costs by the Mann Whitney rank sum test. RESULTS: Patients in the PD group were slightly older (50 ± 11 yrs. vs. 37 ± 10 yrs. p = 0.001) but gender, etiology of pancreatitis, preoperative endocrine and exocrine insufficiency, operative indications, and complication rates were similar between groups. In the two years preop, the mean # admits per year (2.0 vs. 1.8), days in hospital per year (6.8 days vs. 6.1 days), and health care costs per year (,129 vs. ,712) were comparable between groups. The mean cost of DPPHR was 84% that of PD (,735 vs. ,746, P = 0.019). Postop, the mean # admits per year (0.7 vs. 0.4), days in hospital per year (3.8 vs. 2.5) and health care costs per year (,729 vs. ,859) were no different between groups but the # of admits (P = 0.007) and costs (P = 0.01) were both significantly less than preop. Improvement in the VAS at 12 months (DPPHR 78% vs. PD 75%) deteriorated slightly at 24 months (DPPHR 61% vs. PD 63%). CONCLUSION: Both DPPHR and PD are expensive operations that are equally efficacious in pain relief, decreasing hospital admissions, and lowering health care costs in patients with chronic pancreatitis.

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