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Prevalence and Risk Factors for Pancreatic Insufficiency After Partial Pancreatectomy

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

This study aimed to determine the rate, timing, and predictors of diabetes and exocrine pancreatic insufficiency after pancreatectomy in order to inform preoperative patient counseling and risk management strategies.

Methods

Using prescription claims as a surrogate for disease prevalence, IBM Watson Health MarketScan was queried for claims patterns pre- and post-pancreatectomy. Multivariable models explored associations between clinical characteristics and medication use within 2 years of surgery.

Results

In total, 18.96% of 2,848 pancreaticoduodenectomy (PD) patients and 18.95% of 1,858 distal pancreatectomy (DP) patients had preoperative diabetic medication prescription claims. Fewer (6.6% and 3.88%, respectively) had pancreatic enzyme replacement therapy (PERT) claims. Diabetic medication claims increased to 28.69% after PD and 38.59% after DP [adjusted relative risk (aRR) = 1.36 (95% CI 1.27, 1.46)]. Other associated factors included age > 45, medical comorbidity, and obesity. The incidence of new diabetic medication claims among medication naïve patients was 13.78% for PD and 24.7% for DP (p < 0.001) with a median 4.7 and 4.9 months post-operatively. The prevalence of PERT claims was 55.97% after PD and 17.06% after DP [aRR = 0.32 (0.29, 0.36)]. The incidence of postoperative PERT claims 53.98% (PD) and 14.84% (DP) (p < 0.0001). The median time to new PERT claim was 3.0 (PD) and 3.2 (DP) months, respectively. Claims for both diabetic medications and PERT rose sharply after surgery and plateaued within 6 months.

Conclusions

This study defines prevalence, timing, and predictors for post-pancreatectomy insufficiency to inform preoperative counseling, risk modification strategies, and interventions related to quality of life.

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Funding

This research is funded by the Columbia University Pancreas Center, Columbia University Medical Center Department of Surgery, and Columbia University Medical Center Department of Obstetrics & Gynecology.

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Authors and Affiliations

  1. Department of Surgery, Division of GI/Endocrine Surgery, Columbia University Irving Medical Center, 177 Fort Washington Ave 7GS, New York, NY, 10032, USA

    Alexander S. Thomas, Wooil Kwon, Beth A. Schrope, Kazuki Sugahara, John A. Chabot & Michael D. Kluger

  2. Herbert Irving Comprehensive Cancer Center, New York Presbyterian Hospital, Columbia University Irving Medical Center, New York, NY, USA

    Yongmei Huang

  3. Columbia University College of Physicians and Surgeons, New York, NY, USA

    Wooil Kwon

  4. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea

    Jason D. Wright

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  1. Alexander S. Thomas
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Thomas, A.S., Huang, Y., Kwon, W. et al. Prevalence and Risk Factors for Pancreatic Insufficiency After Partial Pancreatectomy. J Gastrointest Surg 26, 1425–1435 (2022). https://doi.org/10.1007/s11605-022-05302-3

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