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SYNOPSIS OF PANCREATECTOMY OPERATIONS AND THEIR OUTCOMES IN CHILDREN: A NSQIP-PEDIATRIC ANALYSIS
Muhammed Ali Colak
*1, Shruthi Srinivas
2, Yueran Zhang
1, Lindsey Asti
3, A. J. Freeman
1, Sara K. Rasmussen
1, Jaimie D. Nathan
11Abdominal Transplant and Hepatopancreatobiliary Surgery, Nationwide Children's Hospital, Columbus, OH; 2The Ohio State University Wexner Medical Center, Columbus, OH; 3Nemours Children's Hospital Delaware, Wilmington, DE
Background
Pediatric pancreatic operations are uncommon. In this study, we aim to utilize a large database to assess postoperative outcomes of pancreatic resections in pediatric patients and the factors associated with early postoperative adverse events.
Methods
Patients (age?18) undergoing pancreatectomy operations for pancreatic diagnoses between 2012-2021 were identified using National Surgical Quality Improvement Program-Pediatric. Preoperative demographics and comorbidities were compared between patients with and without postoperative adverse events (complications/readmissions/reoperations/death). Postoperative outcomes were compared across operation types. Multivariable logistic regression was used to identify factors associated with postoperative adverse events.
Results
Of the 336 patients identified, 260 (77.4%) underwent distal pancreatectomy, 5 (1.5%) underwent pancreatoduodenectomy, 3 (0.9%) underwent total pancreatectomy, 12 (3.6%) underwent total pancreatectomy with islet autotransplantation, 54 (16.1%) underwent enucleation, and 2 (0.6%) underwent debridement. Indications for operation included hypoglycemia (n=95, 28.3%), pancreatic neoplasms and cysts (n=134, 39.9%), pancreatitis and pseudocysts (n=36, 10.7%), trauma (n=12, 3.6%), and other pancreatic diagnoses (n=59, 17.6%). Median length of stay was 7 days (5-15). In the 30-day postoperative period, 27 (8%) patients were readmitted, 20 (6%) patients underwent reoperation, 85 (25.3%) patients had complications, and there was one (0.3%) mortality. Overall, 106 (31.5%) patients had postoperative adverse events. Postoperative outcomes are summarized in Table 1. Patients with adverse events had a lower median age (10.6 [0.1, 15.3] vs 12.0 [3.1, 15.7] years, p=0.012) and a longer median operative time (226 [144, 340] vs 183 [132, 261] minutes, p=0.003) [Table 2]. They also more frequently required preoperative nutritional support (41.5% vs 13.0%, p<0.001) and had preoperative comorbidities (65.1% vs 34.8%, p<0.001). Demographics and preoperative risk factors are summarized in Table 2. Odds of any adverse event were independently higher in those with preoperative comorbidities (aOR: 2.51, 95% CI: 1.39-4.57) and need for preoperative nutritional support (aOR: 3.94, 95% CI: 1.88-8.54). Patients undergoing pancreatectomies between the ages 3-5 years had lower odds of postoperative adverse events (aOR: 0.17, 95% CI: 0.03-0.80). Other factors such as race, diagnosis, operation type, ASA classification, and operation year were not associated with postoperative adverse events.
Conclusions
In pediatric patients undergoing pancreatectomy operations, preoperative comorbidities and need for nutritional support are independently associated with higher odds of adverse events. Multidisciplinary preoperative optimization should be considered in these high-risk groups.
Table 1 - Postoperative Outcomes and Their Distribution Based on Operation Type
Table 2 - Preoperative Demographics and Comorbidities
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