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FROM TRENDS TO TRAJECTORIES: A 5-YEAR NATIONWIDE ASSESSMENT OF OPEN AND MINIMALLY INVASIVE PANCREATICODUODENECTOMY
Bibek Aryal, Yue Yin, Edward A. Joseph
*, Sricharan Chalikonda, David Bartlett, Casey Allen
Surgical Oncology , Allegheny Health Network, Pittsburgh, PA
BackgroundMinimally invasive pancreaticoduodenectomy (MIPD) has outperformed open pancreaticoduodenectomy (OPD) in cost-effectiveness and outcomes. With recent advancement in perioperative care and techniques in open surgery, OPD has potential to reduce the disparities in outcomes compared to MIPD. In this study, we aimed to assess resource utilization and perioperative outcomes between OPD and MIPD for patients undergoing PD.
Methods:
We analyzed the Nationwide Inpatient Sample database for cancer patients who underwent PD between 2016 and 2020. We compared socio-demographic characteristics, length of stay (LOS), total charges, and perioperative complications between patients who underwent OPD and MIPD.
Results: The sample (N = 10,778) had the majority patients who underwent OPD (89.0%, n = 9,594), whites (64.7%, 6,975), and females (48.7%, n = 5,244). The MIPD group were more likely to be females (52.9% vs. 48.1%, p = .002) and private insurance holders (39.1% vs. 36.2%, p = .049). MIPD demonstrated lower total charges (mean MIPD: $139,047 ± $4,914 vs. OPD: $170,669 ± $2,727, p < .0001), shorter hospital stays (median 5.05 days vs. 7.37 days, p < .0001), and reduced complications compared to OPD [OR:1.40 (1.18, 1.65), p = .0001]. While total charges in both groups increased similarly over the study period, a declining trend in mean LOS (11.49 days → 10.36 days) was observed within the OPD group. Non-white race and private/other insurance correlated with longer stays, higher charges, and more complications.
ConclusionsWhile a decreasing trend in LOS was observed in the OPD group, MIPD consistently demonstrated advantages in reduced complications and low total charges. The trajectories of changes remain similar in the groups throughout the study period. Despite advancements in perioperative management, MIPD continues to show significant advantages over OPD.
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