, Volume 13, Issue 10, pp 1798-1805
Date: 09 Jun 2009

National Complication Rates after Pancreatectomy: Beyond Mere Mortality

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Abstract

Introduction

National studies on in-hospital pancreatic outcomes have focused on mortality. Non-fatal morbidity affects a greater proportion of patients.

Methods

The Nationwide Inpatient Sample 1998–2006 was queried for discharges after pancreatectomy. Rates of major complications (myocardial infarction, aspiration pneumonia, pulmonary compromise, perforation, infection, deep vein thrombosis/pulmonary embolism, hemorrhage, or reopening of laparotomy) were assessed. Predictors of complication(s) were evaluated using logistic regression. Their independent effect on in-hospital mortality, length of stay, and discharge disposition was assessed.

Results

Of 102,417 patient discharges, 22.7% experienced a complication. Complication rates did not decline significantly over time, while mortality rates did. Independent predictors of complications included age ≥75 [referent, 19–39; adjusted odds ratio (OR) 1.34, 95% confidence interval (CI) 1.2–1.5, p < 0.0001], total pancreatectomy (vs proximal, OR 1.29, 95%CI 1.1–1.5, p = 0.0025), and low hospital resection volume (vs high, OR 1.61, 95%CI 1.4–1.8, p < 0.0001). Complications were a significant independent predictor of death (OR 7.76, 95%CI 6.7–8.8, p < 0.0001), prolonged hospital stay (OR 6.94, 95%CI 6.2–7.7, p < 0.0001), and discharge to another facility (OR 0.28, 95%CI 0.26–0.3, p < 0.0001).

Conclusions

Despite improvements in mortality, complication rates remain substantial and largely unchanged. They predict in-hospital mortality, prolonged hospital stay, and delayed return to home. The impact on healthcare costs and quality of life deserves further study.

To be presented in part at the Society for Surgery of the Alimentary Tract, Digestive Diseases Week, Chicago, May 30–June 4, 2009.