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IMPACT OF BENIGN VERSUS MALIGNANT PATHOLOGY ON OUTCOMES FOLLOWING PANCREATECTOMY: AN ANALYSIS USING ACS-NSQIP DATA
Sourav Podder
*, George Ibrahim, Scott Koeneman, Christine Schleider, Scott Cowan, Nader Hanna
Surgery, Thomas Jefferson University Hospital, Philadelphia, PA
Introduction:
The American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP) targeted database for pancreatectomy provides valuable metrics on surgical outcomes by using clinical data to enhance quality improvement efforts. However, the quality measures provided in the ACS-NSQIP semiannual report do not distinguish between benign or malignant pathology. We hypothesize that the underlying pathology prompting surgical intervention will have significant impact on postoperative outcomes. In this study, we aim to compare postoperative outcomes in patients undergoing pancreatectomy for benign versus malignant masses.
Methods:
Retrospective review was performed of patients
> 18 years of age undergoing pancreatectomy using the procedure-targeted database of ACS-NSQIP from 2014-2022. Logistic regression models were used to compare the postoperative outcomes of patients who underwent pancreatectomy for benign versus malignant conditions, while adjusting for preoperative risk factors. Additionally, a subgroup analysis was performed within the malignant cohort to compare postoperative outcomes between patients who received neoadjuvant chemotherapy and those who did not.
Results:
There were 46,430 patients who underwent pancreatectomy for malignant masses and 16,449 patients for benign masses. Unadjusted, patients undergoing pancreatectomy for malignant masses had higher rates of 30-day mortality (1.6%) and morbidity (35.7%). After adjusting for covariates, patients undergoing pancreatectomy for malignant masses had significantly higher odds of morbidity (OR 1.21, 95% CI [1.06, 1.38]) and sepsis (OR 1.31, [1.02, 1.68]), but significantly lower odds of pancreatic fistula (OR 0.83, [0.71, 0.98]) compared to those undergoing pancreatectomy for benign masses (Figure). In the subgroup analysis within the malignant cohort, we find that neoadjuvant chemotherapy does not increase the odds of 30-day mortality (OR 1.04, [0.55, 1.98]) or morbidity (OR 1.17, [0.98, 1.41]).
Conclusions:
This study demonstrates that the type of pathology, benign versus malignant, significantly impacts postoperative outcomes. Furthermore, subgroup analysis demonstrated that the use of neoadjuvant chemotherapy in patients with malignant masses did not significantly affect 30-day mortality or morbidity. These findings underscore the necessity of reporting outcomes based on the underlying pathology. Future work should focus on integrating pathological data to provide stratified quality measures for pancreatectomy.
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