In-Hospital Mortality after Pancreatic Resection for Chronic Pancreatitis: Population-Based Estimates from the Nationwide Inpatient Sample

Hill, Joshua S.; McPhee, James T.; Whalen, Giles F.; Sullivan, Mary E.; Warshaw, Andrew L.; Tseng, Jennifer F.

doi:10.1016/j.jamcollsurg.2009.05.030

« Previous Next »Journal of the American College of Surgeons
Volume 209, Issue 4 , Pages 468-476, October 2009

In-Hospital Mortality after Pancreatic Resection for Chronic Pancreatitis: Population-Based Estimates from the Nationwide Inpatient Sample

Abstract presented at the American College of Surgeons 93^rd Annual Clinical Congress, Surgical Forum, New Orleans, LA; October 2007.

Joshua S. Hill, MD
- Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, Worcester, MA
James T. McPhee, MD
- Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, Worcester, MA
Giles F. Whalen, MD, FACS
- Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, Worcester, MA
Mary E. Sullivan, MS
- Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, Worcester, MA
Andrew L. Warshaw, MD, FACS
- Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
Jennifer F. Tseng, MD, MPH, FACS
- Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, Worcester, MA
- Correspondence address: Jennifer F Tseng, MD, MPH, Department of Surgery, SOAR Research Lab, S3-752, 55 Lake Ave, Worcester, MA 01655

Received 7 February 2009; received in revised form 27 May 2009; accepted 27 May 2009. published online 20 August 2009.

Background

Pancreatic resection can be performed to ameliorate the sequelae of chronic pancreatitis in selected patients. The perceived risk of pancreatectomy may limit its use. Using a national database, this study compared mortality after pancreatic resections for chronic pancreatitis with those performed for neoplasm.

Study Design

Patient discharges with chronic pancreatitis or pancreatic neoplasm were queried from the Nationwide Inpatient Sample, 1998 to 2006. To account for the Nationwide Inpatient Sample weighting schema, design-adjusted analyses were used.

Results

There were 11,048 pancreatic resections. Malignant neoplasms represented 64.2% of the sample; benign neoplasms and pancreatitis comprised 17.1% and 18.7%, respectively. In-hospital mortality rates were 2.2% and 1.7% for the pancreatitis and benign tumor cohorts, respectively, compared with 5.9% for the malignancy cohort (overall p < 0.01). A multivariable logistic regression examined differences in mortality among diagnoses while adjusting for patient and hospital characteristics; covariates included patient gender, race, age, comorbidities, type of pancreatectomy, payor, hospital teaching status, hospital size, and hospital volume. After adjustment, patients undergoing resection for pancreatitis were at a significantly lower risk of in-hospital mortality when compared with those with malignant neoplasm (odds ratio, 0.43; 95% CI, 0.28 to 0.67).

Conclusions

Pancreatectomies for chronic pancreatitis have lower in-hospital mortality than those performed for malignancy and similar rates as resection for benign tumors. Pancreatic resection, which can improve quality of life in chronic pancreatitis patients, can be performed with moderate mortality rates and should be considered in appropriate patients.